Homestead_Sitzman f ?. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
•
tSTANDARD/SUPPLEMENTAL DEDUCTION FORM
Stele Form (RIS I too) HC10
- +J;
'•f_, Pmicnbed by the Department of Low Government Finance
INSTRUCTIONS See reverse side for filing Instructions
NOTE Telephone,Social Security,drivers license,state identification and federal Identification numbers are cOnfidental under IC 6-1 1-12-37
.. • CERTIFICATIO_N STATEMENT.
I(We) Daniel J. &Caroline A$Itzman certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tex Standard
Deduction is hereby claimed on the date this application Is signed, (date of signature). I(Wey
® Own. 0 Am(are)buying under recorded contract,
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
".
Itit.7...6.7
Recorder's office%Aare contract is recorded Record curets:117m is .40
J `"°.41v..7-e °cur ^w- ,.r, w;";�„a"..' •, g, pR OPERTiDESCRfRTION,_. 5 a.,x �:e r" . ,10yf..r" ..." ,,Mw
Carly Township Teeing district(ply,town,township) -•
Gibson Johnson Johnson .121
Penal number Legal description Is the property In question: (l1l n�p
26-19-35-400-002.705-024 Oakridge Estates Section C 35 121 Real property 0 Annually ki(aakd 6.1.1.7)
If any portion of rho residential structure or the land not exceedingone(I)eve that Immediately sunoundi that structure I.used to ee
of the yproduct(name,des e '
property utilized to produce income. tY,Ie°ibis,
W-"=w r„. „_,. - ;,.€I'ROPEjity:OWNE6F't-:SEIJHER[;ElYCL+A16 A iir,,,,, ',..„›,. a:,, 2r„„,,2_„ , p • , .-
State,County,and Township is claimant vacating a homestead?
. ❑ Yes ® No
)S4gn of ,ram
I hereby certify the above statements are true,correct,and complete. Q" _
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Address of contact(number and strait cry slate,and ZIP cods) Address of angled home ad if any(number and street oily slate and ZIP Code(
4041E White Oak Ln, Haubstadt,IN 47639
f
- g55ESSOH USr $i Y. r #j t ScFSSLU VALUE ril - HOMLST1',D VAL( I, v N0,tJtRESIVEM1TIAL ° .t"=
Land not exceeding one(1)acre Immediately
surrounding residential Improvements (1)
Other land (2)
Total land(line 1 plus line 2) (3)
Residential Improvements or Dwelling (4)
annually assessed mobile f , .
manufactured home Garage (5)
Other Improvements le)
Total Improvements(line 4 through Ilne 6) (7) •
Total value(ins 3 plan line 7) (0)
I hareby certify the above is true,correct, Sgnawra alAsseaser Date signed(month,day,roan
and complete.
Verifying action•Signature elaurditar Date signed(medic,day,year)
,e"..1 ,y ", :r,°• .tic :.;' •.,t.. ,.;... _
._.,,•,. ._ ._,.,..._ _ . � _ ., ... ,."•STAN0r1RD�EDl1CTION'A L`L�OIVANCE�°:� - -, v `"174 . .::i.P; .�, ,-.Pl.
20 pay 2D Lesser of 60%of the assessed value of the homestead or S45,0110.
Nohvilhstendinp any other provision,the sum of the deductions provided in IC 6.1.1-12 to a mobilo home S
that is not assessed as teal property or to a manufactured home that is not assessed as reel property may
not exceed one-hall(1r2)of the assessed value of the mobile home or manufactured home.
Sign•:are el Auditor 1 • Dale signed(month,day,year)
OIBUTION[-Original.County Auditor Fite.6tamped Copy-Toaa y:yer •v' •
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