Homestead_Blair PERTY
STANDARD/SUPPLEMENTALODE DEDUCTION FORM -7Y, q
EAR
�:.-.2.w. CLAIM FOR HOMESTEAD TAX
+3�' Sea Form
m S (R17l 1n6) HCIO W\ 1 .
�7 Ravibed by the Depam.w6 to Local Government Farce
INSTRUCnoNS:See reverse side foaling instructions.
NOTE Telephone,Social Seaady,divers icense,stale item and federal idertacation numbers we confide:tat under IC 6-1.1-12-37.
I(INe) 1 e certify that I(we)occupied as my(our)principal
place of )buying le .Ooxirg described real property under contract for winch a Homestead Property Tax Standard
�Ded/yawn is hereby claimed on the date is appfxation is signed, (date of signature). 1(We):
( Own. 0 Am(are)buyingld under coo p cooperative
centred
'LJ�m(are) entitled to oc ipy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to ocapy the property under the terms a a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the poverty.
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Recorders Dace eats motion is recorded Reod camber Page
I 1
'. -•. YROPERTY DESCRIPTION -- .. - ,.� r •
County Tam L'. .��' Taag datid(�:town,annsp)�
•
er-
facet arts Legalg - Is the property in gwsHwx
G BSON COUNTY AUDITOR ❑Rea property ❑Ar.smcy assessed moms tome(IC 5-1.1-7)
If as pagan a the r :Mature or e.Imsd not exceeingaret)one that iamedtely arnax,ds Nat endue is used to moan Income,desama one use and potion
d the property Lazed le produce intent
2,..-6 - 33 - y o -GOO -0 4 .
` -- -• ". `• PROPERTY OWNEDELSEVYHERE BYCLAIP.MANT - Y •u, ...
Sate.Cody,ad Township Is dairnani vesting a homestead?
0 Yes ❑/No l '
I hereby certify the above statements are true,correct,and complete. Cu•
, /��
Address of contact o W ct(numb stint.city,gate,and BP cock) assaed ism(@.,rmba \\\C4 na y
-ASSESSOR USE ONLY - ASSESSED VALUE . -.I HOMESTEAD VALUE -r.l:On-RESIDENTIAL
.�_- � `- ...''Is.-.!-tr :VALUE
5 noundLand not N residential oneimprovementsacre t !!Iy (1) G.� c '2 4f .
Re
(2) ..: '•E' +• t
Other land �e u ��-:�--
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) q,-r - •'"`.-a s" _--
ennmly assessed mobile
manufactured home Garage (5) y. ..,. ._ .
Other)mprovements (6) ._. . 'c". .�-: i
Total improvements(line 4 mroogh fine 6) (7)
Total value (line 3 pits Una 7) (8)
I hereby candy the above is true,correct. Sionave aPc•+Fn on stoned(math,day.heal
and complete.
',Myna eCbon-Signature oAdtar Dam signed(nar1,day.yarn
STANDARDDEOUCTIONALLOWANCE --_ T, ;_` - i
20 pay 20_ Lesser of 60%of the assessed value of the homestead or$5,000.
M1obaMiSta provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $ •
that is not a as mar property or to a manufactured home that is not assessed as real mopetly may
not exceed y of theth assessed webs of or manufactured home. Date1„,ntrspa i1 ` \, \ c \
ERS1RImJiiON:QigaW-CouetyAuface Rue Copy-Tageya�
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