Homestead_Loveless -I—, CLAIM FOR HOMESTEAD
PERTY TAX
44. \ STANDARD/SUPPLEMENTAL DDEDUCTION R
�� , FORM
rt-'�. Slab Farm 5973(R17r 1-16) HCIO
CvIF f Ptesated tg Me Depsaaaa of Larb Goverment France
INSTRUCTIONS:See reverse side for tiring imbucbons.
NOTE:TekAJrone,Social Security,dive'Scene•stale iderr5Swlicn and lecleral identification numbers are mlbdenffal under IC 6-1.1-12-37.
(- CERTIFICASOON STATEMENT . - -•
In) . _�:
I(We) LI��.I. ✓_nil I certify that I(we)occupied-- ; -
place of residence or am(are)buying the Wowing described real property Ter wphact tor which a homestead P •ax I- • r1Q\9
Ded • is hereby chimed on the date this application is signed. Lo 2a///9 (date of Signature`. (We): `\,w\\ Q 1•
0 Am(are)bag under recorded contract. ,�v •i OCy
ar❑ Am(are)entitled to o spy as a tenant-stockholder of a cooperative housing corporation. Id11e t\
❑ Have a benefdal interest in the trust or the fight to ooalpy the property under the terms of a qualified personal residence . - 0 NV
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. N-
-Ar0
• - CLAIMANTS INFORiaATiON `- -- _ .
gdaaua Oval+acre) IA
SCOWSaoeiy axner a demist sparse past sue ogle) Rives fens I lara5rdbn r Ouw ante a damask gaze(fast see digits) awing St es
partztaW My,e{afmrak spouse dares rot law a social scarily mate)
a buying an Contract.Fee SNpe avers rare
Recorders cam Were mead is recorded Read number Page
-;-�' - .. - •. PROPERTY DESCRIPTION t _ls -_-- - ,
Canty thing
r4C , T aL/M1— Jc�
r
�•—I•32—lo3�7 N/.1490/ Is grin Realirefmy ❑Annually assessed matte lxnm(C 6-1.1-1)
If any pawn of ale residential ua9re a de land rw exceeding are(1)sae that nmetSy amnia that sauna¢is used b panne Stoma,desobe the use and paten
of en property steed b produce penile
_,F" PROPERTYowNEDELSEYHEREBY CL:+IAtANi _
51Ye Cant',awl TaermhD�1 - / 501 , •✓ Is lvaatngatbrtrestead7
t`i�ya/k�Lsyr//r1-
,�a4 ` ❑ Yes ❑ No
re
Signalize adamant ��
I hereby certify the above state eats a true,correct ,
and complete. 'tC
Address a muct(rmateaa sheet,day.stet.end ZIPevrt) Adder of seated @ate at:tree(ory.:date,are ZIP cot)
127D/ E /oisS, Qcidetncdelt , . If L/.7(960
•
c '- ASSSOR USE ONLY ,.ASSESSED VALUE H ME OSTEAD VALUE NON-RESIDENTIAL f1-?-
. SE .c : r a >.r - _-. 4., -VALUE _ 1-."'Ai-.
Land not exceeding one(1)acre Immediately pAW74- l`tr 1 .-=1=
surrounding residential improvements (1) s cal :s_ Y?'•'... -
e
Omer land (2) a__` x
Total land(line I plus line 2) (3)
T
ResidentialDwelling or Owep (4) -t xr.,z:r4iy' W - =
mouthy assessed mobile e
manufactured home Garage (5) sx n
,,;
Other improvements (6) ...., .,-.; �.- .,r ;hl
Total improvements(line 4 through fee 6) (7)
Total value(tine 3 pas fine 7) (a)
I hereby codify the above is true,comet,
aAasesaar Dag signed(moths,day yen)
and complete.
Veayiq--u• -SkTaa+adA:AYa / Data sicced(ma day. -
20 pay 20 Lesser of 60%of the assessed value of the homestead or$95,000. .
Nott a hstandag any other prevision the sum of the dedrxtions provided In IC 6-1.1-12 So a mobile home f that is not assessed as real property or to a manufactured home that is not assessed as real poperty may
not exceed one-hall(11/2)of the t ssed vase of the mote home or manufactured home.
5�xey/u�br^' / l • /;, +L
jPDate signed(nerd/d- year)
ikii
DISTRISIM N:Qgvml-CavayAu9r.Fa"thamad Con-Tmyeyar
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