Homestead_Shoemaker��
�'"' CLAIM FOR HOMESTEAD PROPERTY TAX ,v a
; _. ? STANDARD / SUPPLEMENTAL DEDUCTION Hc�o "
srace Form sma �a,z i s-0s� 20
•S : Prescnbed hy the DeOartment of Local Govemmant Fir�ance
INSTRUCTIONS: See raverse side for filing insfructions. ' �� �I
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�(yye) cerlify that I(we) ocwpied as my (our) prindpal
place o( residence or am (are) 6uying the following described real property for which a Homestead Property Tax Standard Deduclion is hereby daimed
undu conVaU on Ihe date �his applicalion is filed, (date of filing):
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) enGOed ro occupy as a tenanFStockholder of a cooperalive housing corporetion
� Have a benefidal interest in the Wst or the right to occupy the property under the [ertns ot a qualified personal residence Wst
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Name ot tlaimam (legal name)
So�
•
Name of dairtunCs spouse (lega/ name)
Sodal Secunry numDu of tlaimanPS spouse (last (rve d'gRS) Drivefs lirtnse I ICenti9cation I ONer number Issuin9 Stata
of daimant's spouse (la9 frve dqifs)
• ••� �
I( buying om m�trscf, Fee Simple owners name
Recorders ottxs where mnvact is recarEed Remrd number Page
..�. . � • �
Caunry Township T' EisUir2lcilY• t , toK+1shiP)
Pamsl number Le9al destriC�^ T P��iwC�..% Ot 8(J I'• e P eal�PenY �❑
Annuapy assessed rtnhle home (IC 51.1-n
�any portim of Ne residentlal swcwre w Ne land not exceeding one (1) acre thai immeAiatey wrtound al swcnire is used W produce iMane, desaibe Ne use anE portion
f ihe property utif¢e� ta Woduce inmme.
I,�b-18-�3 -�lo�i-ooD. 5�! -oa. 6
-.� . .: . .
CounN Township � �+nry � T°`"^sNP
I hereby certify the a6ove statemenis are We, mrted and complele. Siy �f d iman '
�
Atltlress (numbe� antl streeL c+ry, sfate, aM LPCade) � O I � 1 r O � � �' + r � i' I�
, ' _ H l �O ,.,.
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•" • ��'. �
Land not exceeding 1(one) acre immediately �'�""�� .�, ry'� "t'"`�` -y� �w��=:
sunoundin residendalim rove+nents. (�) ` �'" - �-�'•''���"' �-5'`-'
Other land (2) -;:� :`�� ���'�
ToUI land (line 1 plus line 2) (3)
�:•.�,y � % -ra.. � �.-�r
Dwellin9 (4) �: i��S.sf s:Yh£°t.=2
Residential improvements or Mnualty .4
Auessed MoEile 1 Manufactured Home --� � `�v, � � � � ��h ��.ii
Garage (5) �..r<��.�:.:..�.�`�:�' .�"�,.—'_'.
� Y�r .
Other impmvements (6) ..2 `=Yt_�t. .:
Total improvements (/!ne < throug� line 6� (7)
Total value (Ilne7 plus ltne 7� (b)
I hereby certify the ahove is true, correct, Sy�ture atASSessor Date sgned (monN, aay, yea�
and complete.
VaiA'ing atlian - S5naNre ot twditor Date signeC (rtronN. daY Y��
� �.-� � � � •
20 _ pay 20 _ Lesser ot 60% of the assessed value of �he homestead or $45,000
/dptwiysfaM'ug eny Wherpmvision, Ne sumW Ne deduclions provided in IC G7.1-f 2 to a moWle frort�e Naf is g
rpt assessed es real property w!o a menNacturad hwne Nat is rrot essesced as rael P��Pa�Y �Y �t exceed
one-haH (72) d Ne assessed rdlua of the moGde �ome ar manutactumd home.
$IgnaWre olAUditnr Date signed (rtanM. tlaY. yea�