Homestead_Engler ---rsi, CLAIM FOR HOMESTEAD PROPERTY TAX
4 a STANDARD/UPPLEMENTA DEDUCTION FORM YEAR
srz Form 5a73 pt1T11-1h) HCIO -2,01 1
Presorted by the D .. ..or Loud Go.earea estate
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INSTRUCTIONS:See reverse side losing hstradmns,
NOTE:Telephone,Soda/Security,dices femme,state idemfdcation and federalIderd3ralm numbers ate mrdde:dal under IC 61.1-12-31.
CERTIFICATION STATEMENT , _ .
I(We) cot h 1 t t en certify that I(we)occupied as my(our)principal
place of residence or- are)buying the .I-. r described real property under mnbact for which a Homestead Property Tax Standard
�De/duction is hereby claimed on the date this application is signed, (date of signature). I(We):
Ly()MIL ❑ F1m(are)buying Under recorded axiDad1.
llLLfgJJ#•��BB-mm(are) entitled to oa ipy as atenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest hi the treat or the right to occupy the property under the terms of a quaSfied personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Name at
egal name)
04 daimon eA . • e .
Sala d R.CVOs) onyxes lane l ldcf3rtbn,Other manna at deenae(leda.eayrw Irnsq Sime
(
S�d� CA
SodY stony ester sQawa(lest Ca Masts) Driver.barite Ildetskabon/Oder ranter or Cairn et gauze(lest the dodo tssscg State
• 71V (lrplmOb. lc
�yam mamhasee adalsruayn�mEaJ
-- _ CONTRACT RECORDED - _. _
a holm an oxcart,Fee Same mists nand
Readers o5ce•teas contract is recorded Rend canoe Page
PROPERTY DESCRIPTIDN - _ - - -
CaucY Towdip.•. Taxing timid(oy,tomtownship)4o ,•io k ktp.,
PacerIepeldmapfon - Is the property in dune=
0 Real pwety 0 Annually assessed mobae tome(IC 61.1-1)
II cry perks"d the residential Matra a the laid net camel%doe(1)acre eat imurenSeV satwae that seuase is used to poise iiPMC,deemse the use aid piton
of en ptw1y sized tor Y
a ore.
L�._ �Z —. [ngrool L C 3.
-.
" - --- PROPERTY OWNED ELSEWHERE RY.CLAIMART t-, _. -.- .,,.
Soo,Coady,aid Remit Is claimant vacating a homestead?
❑ Yes ❑ No
.ddaorma
I hereby catty the above statements are true,correct and complete. -1 I or/ "�)
Addass d oxdact(nu:tereat sheet day,slate,and ZIP cede) 'y-err liar 3 I. // I_
e--- end
moll nv 244oQ�IOSa ` Ave ce,i,„., ran .
ASSESSOR USE ONLY * ;:) ASSESSED VALUC'i_1 71 ES ic7UVALDE; NOI VALIDENTIALq : 1i
Land not exceeding one(1)acre Immediately fz ,z
surround-mg nisidengal bnpmvemena (1) .'� ' a '
Operand (2) 6lll''OrPAVW`bizrit:
Total and(line 1 plus line 2) (3)
annu llyad improvements w Dwelling (4) /� ?3. t_ -Y _
Rawly assessed mm�tsI [(,{jA ((pl{
manufactured home Garage (5) 'k`.,,v_ t
Other improvements OD ::z ;}^fit, i l_
Total bnpu...n.nts(line 4 through line d) (7)
Total value(line 3 phis line 7) (8)
I hereby certify the above a hue,correct, sir.aae dAssetla Dux doled(err*Max lea)
and complete.
Veayig scion-Siraaae d AuMa Date sired(neat,day,}eat)
"b :'STAI:DARDDEDUCTIONALLOWANCE . _ _ - . - _
29 pay U Lesser of fi0%of Me assessed vase of the homestead or$45,0CD.
Notts testa rpovfsion,the of the deductions provided in IC 61./-1st m a motile harm $ •
that is not asse real property or to red home that is not assessed as real popedy may
not exceed ( der m assessed v‘kof the hone or home.
Cll. 1
Sglavae d Audex ` One( )rod
Imo:(liflm-Coady At/Sane—Sanwa Coy-Tmyayer
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