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Homestead_Hawk r 1J CLAIM FOR HOMESTEAD PROPERTY TAX YEAR STANDARD/SUPPLEMENTAL DEDUCTION FORM n^ State Form Sa73(R19l 1.23) HC10 02-4 Prescribed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructions. NOTE:Telephone,Social Security,driver's license,stale identification and federal identification numbers are confidential under IC 6-1.1-12-37. `' CERTIFICATION STATEMENT I(We)., VI ti) -�jG 11�K certify that I(we)occupied as my(our)principal place of residence or (are)b ying the folio iap descnll real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the dat is application is signed. (dale of signature).I(We): Own. ❑Am(are)buying under recorded contract. ❑ (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. ❑Are(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 �Q� Township 0 r-� Taxing District(city,to forrvrshiipp) _^ Parcel Number Legal Description CJJ Is h Property n question: ` Real Property ❑Annually Assessed Motile Home(IC61.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that immediately sum rid that structure is used to produce income,describe the use and portion of the property utilized to produce income. — 4 3 - o -0009 - 0 2-4 PROPERTY OWNED ELSEWHERE BY CLAIMANT State,County,and Township Is Claimant Vacati g omestead? Yes No Signa re I Clai nt I hereby certify the above statements are true,correct,and complete. /j yt Address of Contact(num:: and street,city,state,and P code) `/'� A ress l Vocal o es earl,if ivy(nu er nit street,city,stale,a t code) ASSESSOR UUSr!ONLY ( ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE LandNotExceeding One(1)Acre Immediately (1) Surrounding ingngResidential Improvement Other Land (2) Total Land(line 1 plus line 2) (3) 414%);41,4:46,\)).\ Residential Improvements or Dwelling (4) AnnuallyAssessed Mobile J Ol Manufactured Home Garage (5) J y .-- . 0 Other Improvements (6) �ie1% _ 6r7ep ` Total Improvements(Line 4 through Line 6) (7) �C© � �Q Total Value(Line 3 plus Line 7) (8) GNT}-Q:l- Signature of Assessor p4$ d(date,month,year) I hereby certify the above is true,correct,and complete. `di?. ne Verifying Action-Signature of Auditor Date Signed date,month.year) STANDARD DEDUCTION ALLOWANCE 20 Pay 20 Lesser of 60%of the assessed value of the homestead or$46,000. 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 pmperty or to a manufactured home That is not asse d as real property may not exceed one-half(1/2)of the assessed value of the mobile home or an ure home. Signature of Auditor s\ram- \c ��� Date Si�rtym ,toy, earki,,., ry . DISTRIBUTION: Original-County\\Vy Auditor,File-Stamped Copy-Taxpayer I f`/) IIv\ f J/G„",'L Page 1 of 2