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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 Page 1 of 2