Homestead_Bruce (17) CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
• �;:t. STANDARD/SUPPLEMENTAL DEDUCTION FORM
. f;' Sae Fan S471(R17 t 1-i6) HOW ZO1
• I. Peesu®ed Of Na Department Or Lod Cowman Rare
INSTRUCTIONS:See reverse side brbbng il4ruc5oi
NOTE Telephone,Social Sxvfy,drivers Foense,Pale idr6.fcadon and federal iden ton numbers m bers are ntder£ral under IC 6-1.1-12-37.
• I(We) mi ' ` . I`(Q • certify that I(we)ocaipied as my(our)principal
place of residence a )buying the following cesaibed real property under contact for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (dale of signature). I(We):
Own 0 Am(we)buying under recorded act.
Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
1 .
❑ Have a b.-ra.fa:d interest in the bust a the right to occupy the property under the terms of a qualified personal residence bust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORI.1ATION ' -- .
Name of dement Nepal rukw
Social
`"�
Mi WC.e .
Sorel Security
.aso scanty richer.) J
It buying on mead.Fee Simple owners name
Recorder's bem value areas is recorded Rand manna Page
_ --PROPERTY DESCRIPTION'S — "
Cast Toeskp Tamp daiu(rdy axe tunsh`p
Pam rancher Legs dencriptal Is to Puberty in giesaxc
0 Res pmpeny 0 Annual),assessed mote home(IC 6/.1.7)
If any portion of the respravl incase or to land not exceeding ere(1)acre that immediately sarxsds that esumae is mad in poxaa Vora,emote to use ma pram
e ere preset/itd¢ea a produce bonne
26 - lLt — ezo-4OO -ro nI . oc\ -OO6.
Etta,Catty,y,ad Township Is datnant vacating a homestead?
0 Yes 0 No •
Solace o1 claimant
I hereby certify the above statements are true,lY)(IeCt,and cempietey yy^r / l / . .•
Adduos S-- (numbarm s apse ay,Sta.edW Amm rcs>Feea mf ct a (ram real meet,city.sale•end Wadi)
. • E2oo 3 0�,a ' -. -- ,A66. 0
-ASSESSOR USE O":CI _ v I " ASSESS D VALUE__ HOMESTE-D VALUE " ,. ' NON-RESIDENTIAL ,-
- �VALUE
Land not exceeding one(1)are Immediately .._,',.y.f t-
surrounding rosidentMl IMPlavements (1) cYl',"1 1:.r.
Other and 3
Total and(lire 1 plus line 2) (3) I}y/ ^
Residential Improvements or Dwelling (4) I i€ -5 s - '1
annually assessed mobile/
manufactured home dame (5) JUL 2-3 LQ11p .>`�_ 9 __-
Other improvements (6) AtC.Z11:347,MtitqP..IN Total improvements(lice 4 through line 6) (7) D/
• Total value(line 3phs Rne7) (e) �(ggnN COUNTYOR
I hereby certify the above is true,coned, Signature O 'ssessp ore ugsad(rrlack daft yen)
and omplete.
Vrtyng aumn-Sigeara dAlters - . .. Data signed(main,my yeag
20 pay 20 Lessor of 60%of the assessed vase of the homestead or S45,000.
Notnehsarldirg any other provision,the sum of the deductions povided in IC 6-1.1-12 to a mobile home $ •
Motet not asse as real poperly or toav manufa led home Nat is not assessed as realpoperly may
not exceed ( �ther�assessed vaVe d the�rrtu�yg\dCl/�_ r manzavdured home. 1
Slghleaedrwd \_`\ L � Deb�Igred(4frt1r,d1)' � ' i
D STrBUITON:Original-CaWyAuffia• S1mwed Copy.Tayayr I"}/yJ(q--
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