Homestead_Brewer (2) e',..r�°�� CLAIM FOR HOMESTEAD PROPERTY TAX ''
'; l STANDARD I SUPPLEMENTAL DEDUCTION
FORM
YEAR
2,, i State corn 5473iRt7r1-2. HC10
:4/ p-esc^ted oy the Cepaame-t o•i_r_a:_=ter.•^'.,..-
INSTRUCTIONS See reverse side for filing instruct on; •
NOTE Telephone.Social Secunty drivers license state identification and federal rse.ntdreation numbers are confidential under IC 6-1 1-12-37.
►:t CERTIFICATION STATEMENT
i;Wei '� • _ cert fy tna!I ccc❑c'e3 as^-y .. c:Fa Face o
resdence or a'^(are:buying the f.. ..:-• -, -_ :.-•a .v•'cr a Homes:eao Property Tar Sa-.,nrc D_-..� = s _._ a—e., e
•s aFp,catcr,s s geed
.n.. El A— a'_ ❑_,- c_ _recc ___z_-1a
❑A (are eO t ed to occupy as a tenant-stooehc'der of a ccope•at•re rc_s c3•ccra'_
te❑Ha+e a bereft:ai interest in the trust or then to Occupy tie open _ce tr-_fe- :7...-s-,., -as .-...
❑= - are,the shareholder c=-. _ - __ _ . _enty that CA rs t'c c.v',:e',
if Buying or Contract Fee Simple Darner s Name
Recorder s Off.te'An-e•e Contract-s Recorded - - vane
PROPERTY DESCRIPTION
J ' 2 . •
.ante.\umber - ._1 Le;a'-esr,p•: el, c.est cr ---
ea.e'dpely ❑Arnua1y Assessed.Ot. r e'-of .0 b.-
if afey coetc-cf tne resda^ta s-_a.,redr the.3'c-_' 'tree v .dst tst•uctere saedtotraducercor cesc'be the aea..•r--
o'toe proceny it zed to p'od;.ce rc^me
.-2...___C — iZ -08 _ 03 -. 0 ° 1 g3 -0
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County a-,_-a^ship -- ^
_ X,nn er'_ - aw 3 r''
I hereby certify the above statements are true correct and r'� complete
\ ^be•at /� ,n ...ef-r.a•e- ='-este3d 'a-r _ -: - ._
AS:ES SOR USE ONLY I ASSESSED VAI UE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately '11 1
Surrounding Residential Improvement 1
Other Land ;2
Total Land(line 1 plus line 2) :3
Residential Improvements or ; Dwelling ;4,
Annually Assessed Mobile I — I �
Manufactured Home Garage :5; A
��
Other Improvements -- — II(6; — — �Y`�
Total Improvements(Line 4 through Line 6) '7) - , ,(0��r
Total Value(Line 3 plus Line 7) '181 (/'r' �( P'vV
S;ra•re:'Assessd- Care Sr,^^ (day CJ
I I hereby certify the above is true,correct.and complete. ON
ler:fyirg Action-S.g^ature of Aud^.dr _--_- a ^920H4'e m_rt^ yea^
STANDARD DEDUCTION ALLOWANCE
20 Pay 2C Lesser of SC'':of the assesse- .- - _ =_stead c•Scg
No6utnstandrng any other provr;'on •he s,:m,f ^e:e-.. --Tit e c• _•-a' S _ - r
rs not assessed as real propert/or to a ra - _roce'y 3/"S- f�I
exceed one-half(L2)of. assessed a•u- --- - - - - ./
S.grature cf A.iditd• 'Dal.Sir r ay Jti
DISTRIBUTION- 7..r;mat-C_.rp i_ditc• v..-S'a tea ap+-'a+nay- (\\\\
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