Homestead_HAley r_ CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION FORM YEAR
tie/ �`1, star Form 5m(i17/1-16) NCI()
�irsl Presorted bi the Department or Local Goverment Femme
INSTRUCTIONS:See reverse side for tiring inductions.
NOTE Telephone,Soda!Seamy,miler's Icense,stale iden55ca5on and federallder n numbers are cormdermal under 6-
Iwo e- (� ' , certify that I(we)OCcll D
place of residence or am(are)trying/Fie following dJ-..'bed real property under contract to which a Homestead Property Tax Standard
Deduction is hereby claimed m the date this-•• — is signed, (date of signahrreMpreb Z[1
o Own. ❑ Am(are)buying under recorded contract
,OO J
❑ Am(are) entitled to occupy as a tenant—stockholder of a cooperative housing corporation. //11��
❑ Have a beneficial interest in the torsi a the right to ocarpy the property wider the tams of a qualified Gpeu IBS sonal Te9Y1
❑ Am(are)the shareholder, partner.or member of the entity that owns the property. IN`���(
. ri‘ UDITOR
• C - - ) • CLAIMANTS INFORMATION _ -- - - .
Name a chard(b name) �
5oda15evaay
Sodl Scatty cumber of d spare(tad ese duels) Driver's(mne I dart rw=l Oar nude d durmast's space(gal eve duds) Using sate
(ggdmde arty if en:Coxes spouse&es In tan a soda/.seemly motet)
a Cuing oncanam Fee Semple covets name
Reorders e5m*here contract is recorded Rand samba Page
- c - ;.PROPERTY DESCR)PTIONT' r "C - --OWTISI ..Canty ToreNp TAtq •(r$
aralteleal
Paad ranter ,lnl�l Ms A Is to prapatyy is question
An" 8 / of,l.Ceh� ❑Red fr Pony ❑A.Tvady assessed mode raze NC 6-1.1-i)
N any porton a toe rendered stri ae or Ms Iasi net eaaatag one(I)Macrecat any anamdsNe�strumae is used b prfl Mecca desaIDe Pe me and poetise
d to prepay tared b practice insane. /iT�._''.�-_
6 - .a g - o 508 - b 6 --6 II- Io - yoo -Oo5! 049-o,4
PROPERTY OWNED ELSEWHERE BYOLAIfdANT; _ Y r..
ada,Canty.add To rWq T Is daimant vacating a homestead?..
❑ Yes ❑ No •
cornea of claimant
certify the above statements are tore,correct and complete.
Address doaGd(manta and sheet City Cob,and HP code) Address dxaabi hsnes4ad,deny(number ertlstint,[dv;s3&,and ZlPmie)
. /7. .(' 4 > / t'• ( 4 - 00 .tt 7 r
ASSESSOR USE ONLY 11,, PdsiI; ASSESSEOVALUE •__.I .HOMESTEAD JALIIEP::+ NOIr:RYESIIDENTI L __
Land not exceeding one(I)acre Immediately s-p. --1_ g-
surmimp
rovements residential (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
annually assessed mobile I v ;
manufactured home Oarege (5)
Other Improvements (6) -,_z.,.._..�r. .........:.....
Total improvements(lire 4 through line 6) (7)
rota/value (line 3 phs Una 7) (e)
1 hereby certify the above a We,corset, Signet/re of Assessor -. - _ Dam signed gnat;day.Seal
and complete.
verifying=ion,Signature oAdaa Dare Wed(moth,day.lean
. .. . :STANDARDDEOUCTIONALLOUA6•CE c-20 pay 20 Lesser of 60%of the assessed vane of the homestead or S45,000.
Nohstths!anmrg any olherprovisiay the sun of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as neat ero es or to a manufactured home that is not assessed as teal property may
not etoeed onehaf(t/2)&teassseeesussedd rake ofthe+mobile home ormansd aachaed hoone.
Siga ds'��� / ./ _' —J)•L/ OSa Wed(mac,damn
DSimarRON:Odgael-Catty Adaar,File-Stamped Coy-Tamaya
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