Homestead_Ford (2) 4. ".:'/'.21.v. A CLAIM FOR HOMESTEAD PROPERTY TAX
1--s.. ALI YEAR
FORM
4a,40,.;:s STANDARD(SUPPLEMENTAL DEDUCTION
It.
HC10
.. I SPe3reisecnFO°ermd by54 7th3e(RDel9pairtim-2e3n)t of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. II •'
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidenti-6 u der 6 .1-1 - .
CERTIFICATION STATEMENT
I(We) 4F' / ,,ie 014 certify that I(we)occupied asfaartr r...1
residence or am(are)buying the RI Il Abed real under contract for which a Homestead Property Tax Standard De 1 is r y 0 ,-.on the
date this application is signed, 1 LI /A 2- (date of signature).I(We):
g,Own. Dim(are)buying under recorded contract.
Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Acji,,,t1 a,
0 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residentyost,-,.r
N COUNTY AUDITOR
0 Am(are)the shareholder,partner,or member of the entity that owns the property.
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
County Township 0\.....„0: Taxing District(city,town.township)
11/)0/04tiVrInt-'° (1719
•
Parcel Number Legal Description j07"rn 0 1 i Is the property in estion:
1 i'-'i 0 5'a..13 Li 4 4 al Property 0 Annualty A,,essed Mobile Home(IC6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that Structure is used to produce income,describe the use arid portion
of the property utilized to produce income,
2 4,-6s _ 5-7 - oll - COO . X13 - o17
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating a Homestead?
El Yes No
X Si Claimant e ./ .
I hereby certify the above statements are true,correct,and complete.
XAddress of Contaci mbar rid street,citeperInd.co P pode) ,. Address of Vacated Homestead,if any(numbe and street,city,state,and ZIP code)
?) - kV P rA IA 1%) 76PS0
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE NONRESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
Other Land (2)
Total Land(line 1 plus line 2) (3)
A
Residential Improvements or Dwelling (4)
Annually Assessed Mobile/
Manufactured Home Garage (5)
Other Improvements (6)
Total Improvements(Line 4 through Line 6) (7)
Total Value(Line 3 plus Line 7) (8)
Signature of Assessor Date Signed(date,month.year)
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor Dale Signed(date,month,year)
STANDARD DEDUCTION ALLOWANCE
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000.
Notwithstanding any other provision,the sum of the deductions 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 is not assessed as real properly may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
ature Au tdetzve.......ye Date Signed(monthyyear)Signofdior / lA ? l
V
DISTRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpayer
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