Mobile Home_Morrow o . CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
State Form S4T3(R17/1-16) HC10
\Mt- Presalbed by Me Cecartnere cit. Government Finance
INSTRUCTIONS:See reverse side for fang insaucfrons.
NOTE Telephone,Soda!Securifx driver's&ease,stale idanbacalion and federal Ideraarion numbers are conEsiertal under IC 6-1.1-12-37.
• I PAle) rkV Incrlf-rat certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following desalbed real property under conisect for which a Homestead Property Tax Standard
Deduction is hereby claimed ce the date this application is signed. - I-ILI (date a Signature). I(We):
not< 0 Am(are)buying under recorded contract
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
O Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
O Am(are)the shareholder. partner,or member of the entity that owns the property.
Uric ci atoon usserriame
I
Nate d clainzas game(legal name)
Socel Seoaity number or dais soma(Ma free opts) Divers License/Idereacation loew number of daimenta spouse(last five cfigits)
(A-previa Linty ape:cants spause rkes rcr have a social senaby number.)
- •
- .
If buyela On .mtal FeScrrtele cents name -
2019
Reorders office levee areas is reconfed Record refuter Page
Gal S N eillaretP5,/
•
T T axing denct(cay,Pen toarneip)
S. T
carb ND0-11 P7-, c_e_Acn Qe OR
Real property ES 4:<:eiy assessed calve home(IC 6-1.1-7)
If any porton tithe reskierou rampare or to land not ceded:rig one(1)acre Mal immediately seroteeds that numire is used to modem inaante dents tie use and paten
of the property tratral to proles Income.
ab -Liag - co - 00
State,Garay,aid Township Is claimant vacating a homestead?
0 Yee /N0
Sgitncf
hereby certify the above statements are true,correct and complete.
'727c-L- 1/7 ert-44n-4-2
Addsess of coned(rants-sit abeet City,etet.at HP axle) Address of vacated hamedeei,I any(number end steer,city.sada at ZIP code)
3 9 lu,S pvto •
. ASSESSOR USE ONLY I -ASSESS EDVALUE'• HOMESTEAD VALUE ly(3 -RESIDE141:1A2A-R-T:
Land not emending one(1)acre Immediately 15;,-;;03-93,t!,.'3571
surroundbm residentia/Improvements (1)
Other land C2) flaaflin
Total land Vinci plus line 2) (3)
Resklantial improvementS or Dwelling (4) r442 ?4:
annually assessed mobile I
manufactured home Garage (5) 4.Jca
ncc
Other Improvements (0) 93‘;
Total improvements(line 4 through line 6) (7) _
Total value(line 3 plus line 7)
Signature of Assessor Oatsscobblirredh.des war)
I hereby certify the above is true,correct,
and complete.
vadytig aufon-Signature alAuctlar Dela signed(month.day,}es)
•
20 pay 20 Lesser of 6096 of the assessed value of me homestead or 345,000.
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assessed as real property or to a manufactured home that is not assessed as real property may
rot exceed one-half(1/2)of the asse value of the mobile home Or inanfdadirred home.
141,fueller Date signed Oren%cleY,Wad
• -(19 .
DISIBIBUTION:Original-CoureyAucaar,ReStamped Copy-Tamara
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