Homestead_Stallings (2) . ''.' CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
i4. ;,'1.1 STANDARD I SUPPLEMENTAL DEDUCTION FORM Y
,�' y rm !1-23) HC10
zr. Prescribed by
6473 the{R19 Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.142-37.
/i t CERTIFICATION/// STATEMENT
r contract for which a Homestead I(We) �+j I 'f' ,. t J t # f. certify that I(we)occupied as my(our)principal place of
residence or am(am)buying the fo�Q�n sf'b ti pnrooppf e un ed Property Tax Standard Deduction is hereby claimed on the
date this application is signed, QA,J/r GP o410114 (date of signature).I(We):
,NOwn. ❑Am(are)buying under recorded contract.
❑Am(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.
❑Am(are)the shareholder,partner,or member of the entity that owns the property. •
' CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded ?�J'�tr+�{ Record Number Page
v)+f
PROPERTY DESCRIPTION
Coun Tow);ip Taxing District(city,town,t r gltip)
Parcel Number Legal Description Is the property\n question:
i XReai Property 0 Annually Assessed Mobile Home(IC 6-1.1-7)
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 and portion
of the property utilized to produce income.
r%I lY _ L I) ,-- 3D -- ?r 7R0-Q 8
PROPERTY OWNED ELSEWHERE BY CLAIMANT !
Stale,Co ty,and Ty**ship_
�ry Is Claimant Vacating a Homestead? Os
) ✓r lA60/d _ EYes ❑No .- j
Signature of Claimant l
I hereby certify the above statements are true,correct,and complete. • , Sba Addre s of Contest(nu kart street,c! fate and ZIP code ace-'SI'lr sad,if any(n ber. et,city,scat nd ZIP cede) a
4/0- Ai7)4Lam-- r 11 ,eft ..r, ,..rI//7���0'A.?6"E !t" t tika/ /Al 11744 0o
ASSESSOR USE ONLY I ASSESSED VALUE ( HOMESTEAD VALUE I NON-RESIDENTIAL VALUE /-5
' Land Not Exceeding One(1)Acre Immediately V
(1) d Surrounding Residential Improvement
Other Land (2) ' $ '. of r
,.C"
Total Land(line 1 plus line 2) (3) 00
.* - ,.,, D
Residential Improvements or Dwelling (4) =; ;/ '/
Annually Assessed Mobile I
Manufactured Home
Garage (5)
as CY
Other Improvements (6) r' A 2 6
Total Improvements(Line 4 through Line 6) (7) (J 2' I/y/j/I//��
i Total Value(Line 3 plus Line 7) (8) / __i V
Signature of Assessor Qlgra'O1 • (drt pnfh,year)
I hereby certify the above is true,correct,and complete. QUAry.��GGA�.JJ)//-
Verifying Action-Signature of Auditor Date Signed(alr3;'rME )
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 $
is not assessed as real property or to a manufactu ome that is not assessed as real property may not
exceed ne-hal(1/2)of the assessed value of the o l ile ome or menumanufactured home.
Signatu A tlit r acer/ DateJS�ign (m/p/n h,/d�,y,,ye ),,/[��} �`
S I Ili V /fW itt
STRIBUTION:Original-County Auditor,File-Stamped Copy-Taxpaye / /
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