Homestead_Stunkel (11) .10;4.� CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
FORM-- _ STANDARD I SUPPLEMENTAL DEDUCTION HC10 I a�
�� State Fond 54T3(Dep/1-20)
\ Prescribed by Ne Department of Local Government Finance
INSTRUCTIONS-See reverse side for filing instructions.
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) S f-et1 ttn W 5 i-vr-4,z1 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 Tax Standard
Deductiondu is hereby claimed on the date this application is signed, /t -//aka a (date of signature). I(We):
ILA. Own ❑ 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.
CLAIMANTS INFORMATION . . - .
CONTRACT RECORDED
If buying on contract.Fee Simple owner's name
-- Record number Page
Recorder's office where contract is recorded
•
PROPERTY DESCRIPTION
County Township Taxing district(city town,township)
. I: ip D
Parcel number�_ I Legal description I is the
property in questionII
/�� 1 .0 l - 7-)� O,D zi I Cilof 1 property ❑ Annually asses oti
t `sr �r� O� g one( that immediately surrounds that structure is used to produce income,describe the use and portion
of she portion of the residential to prod ce incomen or the land not exceeding t)act DEC 2 0 20,2
the property utilized to produce
- x 7i,)
PROPERTY OWNED ELSEWHERE BY CLAIMANT I�pIbTY A rDITOR
State.County.and Township Is daima ,`,, ,
❑ Yelt\ No
Signatur of laimant
�,_/
I hereby certify the above statements are true,correct,and complete. �� /
Address of contact(number and street.city state,and ZlP code) Address of vacated homestead.if any(number and street,city state.and ZIP code)
640 d 30o LY ;wiz L17 7 a-s- NON-RESIDENTIAL
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE VALUE
surroundin• residential lm)•rovementsdiately (1) _ _- -
Other land (2) - --- - _ -- -
Total land(line 1 plus line 2) (3)•
•
•
Residential improvements or Dwelling (4) _ _ -- ----
annually assessed mobile I (-Garage (5) - -- --
manufactured home _- - -- -
Other improvements (6) - _
Total improvements(line 4 through line 6) (7)
• Total value (line 3 plus line 7) (8) Date signed(month,day year)
1 hereby certify the above is true,correct,
Signature of Assessor
and complete. -- - ----- Date signed(month,day year)
Verifying action-Signature of Auditor
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or S45.000.
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(112)of the assessed value of the mobile home or manufactured home. �� I Signature of Auditor
signed(month.day.year)
J (1 2/ a/�e2
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer Page 1 of 2 p( V