Homestead_Hames + • CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR I
E�� STANDARD/SUPPLEMENTAL DEDUCTION I'i
Stale Form 54730217i 1-16) HC10 \'IF
Pmsmted b7 me Department at tnW Goremea Fin®
INSTRUCTIONS:See reverse side for firing uutucbons
NOTE Telephone,Social Seamix divers license,slate identification and federal idenfficayml mantes are confidential under IC 61.1-12-37.
I(We) \ certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following descnbed real property under contrad far which a Homestead Property Tax Standard
Deduction is hereby darned a the date this application is signed, (date of signature). I(We):
►e Own. 0 Am(are)buying under recorded contact.
II (are)entitled to occapy as a tenant-stockholder of a cooperative housing corporation.
• _ - a beneficial irtaest in the test or 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.
atuf a mcentre*Fee Smpe ones Torre
Recorders offi where coital is recorded Read rumba Page
PROPERTY DESCRIPTION' .. .. - - - _
ra,ryl bend* Tam,g am;d tat:town tnsmNp)
Parcel • ltpldcoFrorl is an properly in masboc
0 Real pspaiy 0 Anabay assessed motes home RC 6-1.1-7)
It any por5m et am residential Ntrare ate land ma emeding ore(1)ace that'amsaits$y aurorrds mat structure is used b Iro]une Income,desmme ere use and ratan
a the popery tared b net dorm
6 - �93 _ I0t --000 . 1t9Z-0VA .
r . LA- PROPERTY ELSEWHERE --1ANTe' "-°-, _
Ste,Ccuty aidToms*' Is dai�!:,t vacating a homestead?
�,'��',',� I Yes 0 No
� 1..JJ
I hereby certify the above statements are true,coned-and complete.
Address a correct(number eel street rife.state,and ZIP code) ,. _. . seated .. am(Tvrmtraam-._. ary,s3b,malZ�gd)
.. ASSESSOR USE ONLY _ _- I ASSESSED VALUE • "HOMESTE D\ We `,_) NON-RESIDENTIAL:
Land not exceeding one(1)acre immediately C z+ •gl')xZ-
surroundm .ad surrounding reptusm, .) (1) III .
S11? — T : -- -
Other land (2) t �_ ..
l �
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4) pI IG 2 % 1019 T'v.
annually assessed mobile l
manufactured home Gann?) (5) S ,,. : -�`
Other bnprovementa -_. (8) i Ki�it a1f�C.1.
Total improvements(fin a through fore 6) (7) GItiSC QSJNTY AUD t OR
Total value gine 3 pks line 7) (8)
I hereby certify the above is tore,correct, gagman at Assessor Dab dpnsd(anti.dux yea)
and complete.
Veayag amen-SiPnmre a,Vudbr Dab sicced(m-'ak day.lea)
20 pay 20 Or.r the assessed value m me homestead or 545,000. .
Ita'wElntallGrg any other• tleducaoru provided n IC 61.1-f S •
that IS not assessed as real -:• ••red that isppootass as1031MM ay
not exceee me-kasll/4d TTT.the rmtrb(
Sonars Audis / \h�JJ a Dere red
in .
dSrRaUR011.pgmal Ootasy .' CoOI-Ta cayu
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