Homestead_Finnerty '"'"�'a' CLAIMNA D HOMESTEAD PROPERTY TIO
s; YEAR
(�;� ' STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC10
t�` �// State Form 5473(R 19/1-23) -
`LP•/ Prescribed by the Department of Leca.Government(,hare
INSTRUCTIONS:See reverse side for filing instructions NOTE Telephone,Social Secunty,driver's license state ide r .,n.nd fe al id? g,- -.t u b ar r. ,% _ im C 6-1 1-12-37.
�1• b. . rat ...
(date of signature) 1(Wei
Own ❑Am(are)buying under recorded contract
(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation
1 0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence rust
❑Am(are)the shareholder,partner,or member of the entity that owns the property
IIf Buying on Contract.Fee Simple Owners Name
I
i Recorder's Office N,here Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
_ Township el - - . rown.township)
Parcel Number Legal Description tie prop in question
Real Property ❑Annually Assessed Mobile Horne(IC 6-1 1-7) II
If any portion of the res dentia'structure or the land not exceeding one(11 acre that immed.ately urroun s that structure,s used to produce income describe the use and portion
of the property utlized to produce income i
26 ,_ - 2 -l0I --000 , 23fi--cZ
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State.County,and Township Is ai ant Vacating a Homestead'
Yes ElNo - 1
ignatur ' N
I hereby certify the above statements are true.correct,and complete
Address of Contac number rid street.cl state and ZIP�code) - , cat cmestead.if a umber and street pry.stale.and LP cod 1
S�'O toVGI \1w- � 1 ^�
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE 1 NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
1 Residential Improvements or I Dwelling (4)
Annually Assessed Mobile I ¢ 2
Manufactured Home ' Garage I(5) Et^ll.• 7 20 O
• Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7) GiSSA
LINTY qU
Total Value(Line 3 plus Line 7) (8) D OR O
i Signature of Assessor Date Signed(date m th.
I hereby certify the above is true,correct,and complete. ! , �1
Verifying Action-Signature of Auditor Date Signed(date .$nth,year) rl
-+)
STANDARD DEDUCTION ALLOWANCE 20 Pay 20 Lesser of 60%of the assessed value of the homestead or 548 000 O
0
Notwithstanding any other provision the sum of the deduChons provided in IC 6-1 1-12 to a mobile home that S /�
is not assessed as real property or to a manufactured home that,s not assessed as real property may not �'w
exceed one-half(1/2)of the assessed value of the mobile horn Lured home ��ye�//\
Signature of Auditorry) G Date Signed(m year) nI —
DISTRIBUTION: Original County Auditor File-Stamped Copy-Ten
Page 1 of 2