Homestead_Harmon I?(4/\CI t4 Of CLiv4i-\\
,.,..4.. ".,-; CLAIM FOR HOMESTEAD PROPERTY TAX .......----"-------------- . YEAR
411''''4.' kle STANDARD(SUPPLEMENTAL DEDUCTION ! FORM
Stale noir.5473 Era:8 r 1.20) I .31.-1,022.__ L
,,,,„_,,_,,,,,,,„„e„, Rescribed by Ire Deo-wan-ere or Lncai Grxrerronein nt Foaine HC10
INSTRUCTIONS See reverse side foi fumy disttuchOns
NO rE Telephone.Social Secunty doers license.state identification and faders,identification numbers are confident.;under IC 6-1.1.12-37
CERTIFICATION STATEMENT
I ..
: I(
- buying the followng described reai property under contract for which a Homestead Property Tax Standard
i Deduction is hereby claimed on the date this appiication is signed, (date of n/enature) I(Wet .
Own. ., Are(are)buying under recorded contract. I
I
Am (are);Lobbed to occupy as a tenant-stockholder of a cooperative housing corporation
i..,...1 -lave 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. ,
i
CLAIMANT'S INFORMATION
i
, 1 i
CONTRACT RECORDED
it buying or contract Fee Simple 0W/101.8 wine I
, 1
Recordees office where contract is recorded 'Record number 1 Page I
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PROPERTY DESCRIPTION
County Township „..,,,,,...--,_ Taxing district{city,town teernstap)(.9 ,
Parcel nurobei
CA
.--\0 P '
i
eda!descriptor
0 2 -') 17 7
Is so s qv in question I 0../N
1
; i l Real property 7_1 Annually assessed mobile home(IC 6-/1-7)i
1 ll any portion bless en dental structure or the land not exceeding one(II acre that ininterdiatety son ds Its 1 structure is used to produce income,describe the use and portion
c; I the property utilized to produce income
1 1
(1-2,0o-001 s 06 )---._002,_ "----- 1 ..s....D
PROPERTY OWNED ELSEWHERE BY CLAIMANT ....C.
1 State County.and Towns-up t IS dal nt vacating a homestead, A
Y e n N o
;Signalise of a
I hereby certify the above statements are true,correct,and complete.
...0%,.".: _ ,,......-
LOC.$), siks,,,s Address of contact Mame,and street mry stare and ZIP 400E, t A.,,,,,,,sit.a'..ter,,,,,,,......,,,any(number and Creel day slate and ZIP code)
55Sii yoncin-31r\ i'33.3 N
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ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE NON-RESIDENTIAL
VAt UE CI
Land not exceeding one(1)acre immediately
sdidtial improvements ,; . •
; urrouning resen ............._,_ .1. 1..........
IOther land (2) I
Total land(line 1 plus line 2) _Lit3)
, Residential improvements or 1 Dwelling I(4; .'i
i annually assessed mobile/ i - .
manufactured home Garage1 CD
I 'fist
1- • ..,
es 44, , - _i__,4
, Other improvements ;6) 21,ei,
; ! -1
1 Total improvements(l(ne 4 through line 6) ,l 7) is'l
Total value (line 3 plus tine 7) ,18) i,.
a .
a as_ — -
Siunatise ot Assibit
; I hereby certify the above is true,correct,
and complete. . -
--i
V,-1,1 uCt.-11-S goiffite or Aan t- -1-74C4Rate saored VreInt,'lay yo,
. .
STANDARD DEDUCTION ALLOWANCE
1 20 pay 20 i-rosser or 605 of the assessed value of the horTesteart or$45,1100 '
; Norwitharanding any other prOVISM.O.tin:sure of the dealuchons proy.cfeel In IC 6-1/-/2 re is mobile borne . $
that is not esse sr/rot es tea,property 5150 manufactured home that is not assessed as real properly may
opt exceed one-Palt ilxi;ot list assessed value of the radiate horse or manufactured fanner
1 Signatare rar 7Date si 1.-
xtei(ince n day year; I
1 ,011 e
1 o 2-1 • I
DISTRIBUTION Orsaim Cooi n a Arid tv Tii- CM,/---areal.,
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