Mobile Home_Lance •
"jx�"� CLAIM FOR HOMESTEAD PROPERTY TAX _ YEAR
` STANDARD 1 SUPPLEMENTAL DEDUCTION 1
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INSTRUCTIONS See reverse side for filing instr.ct ons
NOTE Telephone Social Security,driver's license state identification and federai iaentfication numbers are confidential under IC 6-1 1-12-37
��'��'"���� CERTIFICATION STATEMENT
I,,We. ► V) J_4 _ list I i.:e,ecci.cad as .a,c^ro;pa pace or
' re_- __..a .''3.cur-, he ...,.. ._c __. r---=,l:rte.,-o .ace.- a=_r a_o ems_=_;Przoerti Tar S:a .a o D .- s ,-a cs,c , !
da:=? s a�p'ast or i5 S gnstt ate o.S:CnaIa-e/ 1 I"+e t
ct
J = e n are, e a
^to:cc.py as a:erg ^ %holder of a c cape. , e. .errs r.7 cc•ccr3:.c-
❑ria'+e a as.ata_st in ire trust or t-e hoht to=.:_Yy the r per:,,u-der, e t_. _ a a.s t-.oa s.na' ca re =I._s. '
0 A-I fare,the shareholder partner,or member of t`e enttly that oars the cr;e.:, I
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CONTRACT RECORDED 6..)
t Burro cc Oontsa:t"e Sirrpie Ovine.s Pia-e - '1!)
�1'e OLD
a_x:_a : rt a_, e-e.c -tract s Re:ord_d Re_.c ._-der s° _ CJ ea
. 4/ipG 74
PROPERTY DESCRIPTION '
•
Tc1.-is!.' C9 �3r ry C.V. t': ..errs rc `P O/
a-y c. .-c'ire es.d_ .-'str:....re o tre'3-_.c,_ tee: 3:re'ra' '^211.e.f" .ds'mat sr..:v....re"se]'c c:d__C.wire cess-pUe.he-se a^ per:7,--
..'the przzert,.:t red leer_..... ._.me
' 2.....C '-' 140C - cy0-0 Lim_....0 D .
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State Caanfy and Tcs^sh 411/ i is"lair-add.rasa. a -o'-estead'r .
I hereby cerilfy the abcove_rstatetlerts are:rse correct and comc,e:e
%-�d�Si-j^;...d:.:'r-� L.L�ra_�`�... "� - , � � � _ a�i.3:3'? __93.. _'I .'..r'r e'3r:s'r=. ^`/ _.s: d�^.Z.:c. t
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ASSESSOR USE ONLY i I ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately 't1,
Surrounding Residential Improvement i —_ _
Other Land 12
Total Land(line 1 plus line 2) ;3,
Residential Improvements or Dwelling i4;
Annually Assessed Mobile I ,
Manufactured Home ' Garage
Other Improvements
Total Improvements(Line 4 through Line 6)
Total Value(Line 3 plus Line 7) 'a'
— S:ra'.:-e^ ..>.ssr f:a:e S;rad;dace 'r^.r'r,je.e. -
. I hereby certify the above is true.correct.and complete
—
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STANDARD DEDUCTION ALLOWANCE
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2: Pa',27. Lesser of SC': assessed:.___ _'.or-es:eac sg:;_
''.-ot;.. ro a-. :Ire crs >or 'he ,,-S . r.c pro, .7 7C _ er. '
.3-hor asse.ssei as
...___ere-^a,fy',2 cof the at.-.1..,-3'.:;/Tt r��,ur.c _ ca= _r r,ar-e actved-c^_
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. Sigra"-_ci Aid' (.��`��4'v'1" -- - -- - .Date ci a j� day --- .
DISTRIBUTION 2.r:ra--._. , _. _• =-e Y=-e _ A Q
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