Homestead_Bromm is. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
Q,ac STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form 5e75(R17/1_16) HC10 20Et
Pmsaited by Ve Department et tort'Goverment France •
INSTRUCTIONS:See reverse side for bang instructions.
NOTE Tel Soda(Security,admit Lcense,stall identification and federal idnalca&on numbers are confdenVal under IC 6-1.1-12-37.
I(We) , - • certify that 1(we)occupied as my(our)principal
place of residence n-am(are)buying the framing desrnbed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
nL An(are)la log under reCOrded .
(are) entitled to oo ipy as❑a tenant-stocktwlder of a cooperative housing corporatbn.
DV .
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust.
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Abmaf War=(legal name)
3/4 c £
•
Soda(Seedy number at dffivan%spree(last five aces) Dines tense r idetdrrlcn I Dar rer.rote d dammrh spree(fast five rests) Issuing gab
(AsPOOMb riytasp/cares spouse eon in lava a soda(searty,anti)
.. - CONTRACT RECORDED` - -
t runty on contract Fee Sur4e oaefs nave
Bearden oboe otreeaoact is recorded Page
1stai
'''PROPERTYDESCRIPTIOt:t 7.1: -
Caauy 'fit.. q Taping doriC(rdy.asses m*nst4)
PrQa boo^: J no 2019
Rea Property ❑A. moue dame(1C 6-1.1-7)
If airy Paton of the retidrea aurora or re lard not=tee's one(1)erne that inure av eu ' iiooni4 daame me use ac prdm
d daprMety inbred
bproduce bon. 1� ��i1@��SQ� AU D
"pCU-p�0 -0D'^ • . o_1 .L�/V°uC ITOR ^
-'-1-
". - - _
, -+ . :PROPERTY OWNED ELSEWHEREBYCLAIHANT.- - -.'S. .
Sam,Carty,and Township claimant vacating a homestead?
0 Yes ❑ No '
I hereby certify the above statements are tore,correct,and complete. a
Addrm d an'ad(rwmbrend•beet sole arc TiPmdb) �''d;e--
(ambartlstRd,(ti: +r Z�....
i (S'y` 1 e 07---On —
-ASSESSOR USE ONLY - 'Jr!, ASSESSED VALUE,; i HOHESTE D VALUE
nd ,.j_j fOtt ygLUENTIAL -,�,
Le not exceeding one(1)Gore bnmedatsly .•. - •._. El
, ..if V.
surmund 'z
mg residential improvements (I) -r, . _gc .E-fxl,;Jna �J
C
Other
land (2) tL�.��'`_'...'s-.-.rx .
Total land(final plus line 2) (3)
Residential improvements or Dwelling (4) r' y `r,O
annually assessed mobile I s s _' ,,w
manufactured home Gauge (6) _.z$_ . .-- ,<. ..- ...
Other improvements (6) ;':t? ;y,. .r-;t�:- .
Total Improvements(line 4 trough erne a) (7)
Total value(lire 3 pis line 7) (8)
I hereby certify the above is true,coned, Signature ctAssaoor Oats signed(nsxrk day,yar)
end ccanplete.
Vetyi9 edion-Signature of Amber Dam signed(oath,day.nee
., _ - "" "-STANDARDDEDUCnOI4ALLOWANCE -.c .:'. . -
20_ I Lesser of 60%of the assessed',due of the homestead or 645,000.
other provision,to fof the deductions provi4'd in . b a rrobtle home S
that is not - real properly or .nufac4rme nati 1assesseda alp(operly may
mf exceed. e .»of the aa of the rr home manufactured I �s err ...
SgWsed • T Date demi unmet'
dSIR®IIR... • ...._CawafAsdaa,--- .-.Copy-Tage)v
Pepe 1 of