Homestead_Koch (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
" "0 STANDARD J SUPPLEMENTAL DEDUCTION
``r HC10
•`-trams State
Prescribed by the Department of Local Government Finance
INSTRUCTIONS_See reverse side for filing instructions.
NOTE-Telephone,Soda!Security,drivers license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) i ) certify that I(we)occupied as my(our)principal
place of -nce or a (are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deductiereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. 0 Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Recorders office where contract is recorded Record number Page 44.1.
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PROPERTY DESCRIPTION
i
•• ly r Township Taxing di ',foam,t y hip) ' -4,t&t
„I)
i< 1. . , 0< j� .4Fc11.
Parcel number /n✓� / bagel description Is the in question: Qi
dtAdo `o2 O ./`JO,. QQOI 4 i aO/ Real property 0 Annuariyassessea lee 6-1.1-I, �ZO,
If any/arty portion of the residential0 structure or the land not exceeding one(1)1)sae that immediately smi ids that structure is used to produce income,describe the&,,aainr •.-i.•
of the properly utilized to produce income. `'O ►�
Gary •%'
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PROPERTY OWNED ELSEWHERE BY CLAIMANT O•f
State,County,and Township Is claimant vacating a homestead?
0 Yes 0 No '
Signature claimant 1...
I hereby certify the above statements are true,correct,and complete. �`
Addrreessgof contact(numberrendsheet;city state,and ZIP code) / 97//:!'A of vaca homestead,if any(numberandstreetcity,state,and ZIP code)
iF i�Ov l S. 5/A to l)tY , ,:rle for , w
ASSESSOR USE ONLY t ASSESSED VALUE { HOMESTEAD VALUE NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately t1) ,
surrounding residential improvements >..::
Other land (2) r , y.
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) t i _r,
annually assessed mobile I _
manufactured home Garage (5) •
3.t r.
Other improvements (6) '
Total improvements(line 4 through line 6) (7)
Total value(line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 I Pscer of 60%of the assessed value of the homestead or$45,000. .
Notwithstanding any other provision,the sum of the deductions provided in 1C 6-1.1-12 to a mobile home $
that's not ass- ed es real prope, a manufactured home that is not assessed as real property may
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not exceed aff(112)of the- - .value of the mobile home or manufactured home.
Signature of• / Date signed(month,day,year)
DI TRISUIION:Original-County Auditor,File-Stamped Copy-Taxpayer
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