Homestead_Burcham TAX
iirOs aZ1141Dog7/EISOURIgP2LIZIEENTPARLOZAZTION FORM YEAR
HC-10 2
Pr:crEed by the Departolent of Local Government FInance
INSTRUCTIONS;See reverse side for filing lnsfrucbons.
NOTE;Telephone,Social Security,drivers license,state identification and federal identification numbers are confidential und 6- -1 37.
CERTiFICATiON STATEMENT
I(We) e 41,
ertify 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 KNrtIT*SrSid
Deduction is hereby claimed on the date this application is signed, (dale of
Ure
E] Own. LI Am(are)buying under recorded contract.
El Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. r2,,citagiCe...
LI Have a beneficial interest in the trust or the right to occupy the property under the terms of a quefikfric9WESITOR
E] Am (are)the shareholder, partner, or member of the entity that owns the property.
CLAIMANT'S INFORMATION
It buying on contract,Fee Simple owners name
Recorders office where contracts recorded Record number Page
PROPERTY DESCRIPTION
Cooety Township Tauleg dint city,learn,township)
Parcel number
,L.. LI Real property LI Annually assessed mobile home(IC 6-1 1-7)
It any property utilized to produce income, income describe the use and portion
01 the a 6, 0 CX 'foO - 00/ - 01,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township
Yes F.1 No 2.C,.-2.3—0 2 00—40 •
Signature of claimant
I hereby certify the above Statements are true,correct,arid complete.,)<'
Address of contact lncm va lltr et,city, 'teen.ZIP cod-) 4> Address of vacated homestead,If any lnumber and street,city,01st:.and ZIP code)
Li A
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL k 0 rvi
Land not ilZ7gilgn't'r:if,1),,:igt immediately I 1)surroundV
Other land (2) 1.:474722:0:Zigggi
Total land(line 1 plus line 2) (3)
manufactured home
,
Garage (S)
Other improvements
,
(6) IV' 31/11C1
Total improvernents(line 4 through line 6) (7) TI/29 /
Total value (line 3pkw line 7) (8) 2-gpes
I hereby certify the above is true,correct,
and complete.
Verifying actrorr-SigoatorelltAuldltor Date signed lmonth,day.year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lessor 0160%01 the assessed value of the homestead or$45,000.
Notoiithofon ding any other provision,the sum of the deductions provided in IC 6-1,I-12 to a mobile home $
that is not assessed as coal property or to a manufactured home that is not assessed as coal properly may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. (
areoflt
-' //7e,- DT9
Dl5TRiBUTiON Original-Couety Auditor,File-Stamped Copy-Tanpayer
Page 1 012