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Homestead_Luff . CLAIM FOR HOMESTEAD PROPERTY TAX tO !TANDARDR./SUPPLEMENTAL DEDUCTION FORM Prescribed by the Department of Local Government Finance — HC113. YEAR tcl ._ 1 INSTRUCTIONS:See reverse side for filing instructions. &A-151',-rvn. [7] Am(are)buying under recorded contract. LI Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. El Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust. 0 Am (are)the shareholder, partner, or member of the entity that owns the property. If buying on contract.Fee Simple owners name Recorder's office where contract is recorded Record number ilk 12) PROPERTY DESCRIPTION Coun To hip Taxing distrIct(city town.t•,n fr. ) Parcel number Legal description Is the prti,9xfX9111 eal property [__._] Annually'as4*Illetyme( -/.17)- If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income.descrireqieuse and portion of the property utilized to produce income C=7 .LO ." .\ .'- ..". '''' CC) *". CDOC)'-k.uA CY-" ,—. CO LA PROPERTY OWNED ELSEWHERE BY CLAIMANT State. ounty.and Township Is claimVroacating a homestead? I (..0.( ic,5421,-`s. Yes [I] No Sq•aturr.of cl.imant I hereby certify the above statements are true,correct,and complete. ke . lirr Aof / wt.,. .....,,..,A Address of contact(number and street.city,state and ZIP code) Addl..,acated homestead,i-toy(number 417 e t,i Otte.and Z/Pcode) 4 4)0 e . 4:= • . rano.'.; • • ..1. ,- . ... , , • so i • 15-1 car\ t'S. , ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL VALUE 1 Land not exceeding one(1)acre immediately h ) . .. . ., ., . . surrounding resident improvements (1 ,'',..---,4:',-.142-Wi,'''‘-i -,..'-:.•,;=:.iT=)1.,.., Other land (2) .44444,4 .J41/4-1 • Total land(line 1 plus line 2) (3) Residential improvements or Dwelling (4) ---:41- -ii -, -- -2-i'lA \-"\--1. t...0--7 annually assessed mobile/ manufactured home Garage (5) Other improvements (6) lr,''W•la -„ " :•„1 Total improvements(line 4 through line 6) (7) Total value (line 3 plus line 7) (81 Signature of Assessor Date signed(month day.year) Ial,..r1g=iefy. the above is true,correct, Verifying action-Signature of Auditor Date signed(month,day year) STANDARD DEDUCTION ALLOWANCE 20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000. Notwithstanding any other provision,the sum of the deductions provided in IC 6-1 1-12 to a mobile home $ that is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home. Signature of Arkditor 3- Date signed(month,day year) .-\„......m0 DISTRIBUTI NI Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2