Homestead_Naas (14) •C9: CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
_, FORM
�.:: STANDARD/SUPPLEMENTAL DEDUCTION //�� Cj is: aih„i.r ` Stab Faro 5473(R17/1-16) HC10 01
Presaae:y the Department at Land Goverment Frame
INSTRUCTIONS:See reverse side fording huhu:gong
NOTE Telephone,Social Seaway,CriveYs scene,state ilen5.fra5on and federal idanalra6on numbers ere canfitSl wider IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I Me) q/ C • certify that 1(we)occupied as my(our)principalplace of residence or am(are)buying taeng de5scnbed real property under contract for which a Homestead Property Tax Standard
Dent • hereby claimed on the date this application is signed. (date of signature). I(We):
) Own ❑ Am(are)buying under recorded contract
❑ Am(are) entitled to ocaipy as a tenant-stockholder of a cooperative housing corporation.
❑ Flaw a beneficial interest in the trust a the right to occupy the property under the terms of a quaGied personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Name of
Lovrn(mar name)'M �ata.s .
Soda)
Nana aclabatlY space(leLalr"
S lien ‘ IwkS
Stan storey raanbr of=nines space last five dgnf-DdwYs coma/ldavihrmm 1 Omer ranter of Batman s-;- bating State
Qtgai sinaya.�. _ -- - ,mile
- ).,cop ! ' ';Ilit
- '- - CONTRACT RECORIIED J „ _ . . - .. -
Ifbuying on caraa.Fee Simple miners rare
MM 8 2019
Recce s ogee where mama is recorded -Rand M,bv Page
-1 - PROPERTYDESCRIPTION'.;'Litr..Y.'c �' .:;td J- . ..
Canty ` r �n TadgdsvHl-' "ill' i. Y AUDIT0"
Y� d��yV GIBBON •
-
Patel lager aesap:m bee property Is gren:a
❑Rep rNwiy ❑Arnnfy assessed mote tone(IC 6f.14)
It any poison d to mann:is!stare a the taxi nor aaeffiiq aro(1)ace that innMxYly wards ton sbnmre b mad b nor®Fume,describe 4e use all poem
d the property tabs to Prof Q inane.
: 6- - 3i `+� �02 fi e -0zy .
-- :PROPERTY OWNED ELSEWHERE BY CLAIMA nT ._. . -- ..
Stab,Casty.at Toschq Is claimant vacating a homestead?
\/ ❑ Yes ❑ No
I hereby certify the above statements are true,correct,and complete. x er n/ MA M /fit/3.••
Abbess of coma(neater awl sheet city.stab aid ZIP age) '\ of ravbd I'.-.acl retry V(bamUaaat street.sal.nab at ZPcode)
2 $oZ (A) So bran . Ycflh ,
. ASSESSOR USE ONLY- -- i _.ASSESSED VALUE HOh1ESTEAD VALUE_.SI .}.NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately ,(1) —' µ11l" '' :-'. z,
d sorroa "mg residential bnprovements
Other land (2) _`r- fi`Vri 84:.`_4
Total land Dine I plus line 2) (3)
Residential improvements or DwellIng (4)
annually assessed mobile I
manufactured borne Garage (5) L§.-.>s '.`.-^,. K. jy
Other improvernents (6) 4 lY,,:�)_4_ x:.�%p .
Total Improvements(time 4 through line 6) (7)
Total value(line3 piss Tel) (6)
I hereby certify the above is truer correct,
signature of Assessor Dab shed(area day,y.a)
and complete.
l4ifybp anion-Signature cAudtr Dab sired(maa day.year)
-� - _ - STANDARD DEOUCTON ALLOINAWCE .. .,
20 pay 20 Lesser of 60%of Se assessed value of the homestead or$45,000.
No:withstanding any other provision,the sum of the deductions provided to IC 61.1-12 to a mobile home S •
mat is not assessed as real property or to a manufactured home that is not real properly may
not agreed one-ha(1/Q.o-f the assessed vaarn core mobile home or actred a7{�[�
SiraseecrArrtbr ` ` re , \k S `► �� S Date ^-L V� 1 q .
DISTRIBUTION:OriginalJCastyA`AAedda`,Pile-Stamped CopyMTe p yer
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