Homestead_Straw (7) } CLAIM FOR HOMESTEAD PROPERTY TAX FORM
_ YEAR
• STANDARD/SUPPLEMENTAL DEDUCTION
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. + State Form64 HC10
73(R19/1.23) I� Jar
11.
Prescribed by the 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 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) Q(`{3'i Q A 4-e a-r,`e, i t-Q - certify that I(we)occupied as my(our)principal place of
residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard Deduction is hereby claimed on the
i
date this application is signed, "1.1,- (date of signature).I(We):
wn. ❑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.
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CONTRACT RECORDED
If Buying on Contract,Fee Simple Owner's Name
Recorder's Office Where Contract is Recorded Record Number Page
PROPERTY DESCRIPTION
C000�gmyy - Township
Taxing District(city,town,fownsfri ^ 1
Parcel Number Legal Description Is the p in question:Q L
Real 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 structureis used to produce income,describe the use and portion
of the property utilized to produce income.
aW t\r\—\Th._ Lk CIO —COS sr L.o -{2•--4 l
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is Claimant Vacating.,a Ho st. ead?
/� ry 0 yes afg
ra
p Signature o�an E/[ J( ---
I herebycertify the above statements are true,correct,and complete.
Address of Contact(number and street,city,state,and ZIP code) Address f Vacated Homestead if any(number and street,city,state,and ZIP code)
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ASSESSOR USE ONLY ASSESSED VALUE ' HOMESTEAD VALUE NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately (1)
Surrounding Residential Improvement
,,
Other Land (2) i:
Total Land(line 7 plus line 2) (3) •
Residential Improvements or Dwelling (4) a a
Annually Assessed Mobile I
Manufactured Home Garage 5
- E''
O , f.,
Other Improvements (6) c a
-
Total Improvements(Line 4 through Line 6) (7) /Q
Total Value(Line 3 plus Line 7) (8) �R 1 }
Signature of Assessor Date Signed rills nt,year)
I hereby certify the above is true,correct,and complete.
Verifying Action-Signature of Auditor {?tgs ate Signed(date,month,ye-)
ANC .. 1,
STANDARD DEDUCTION ALLOWANCE
b/
20 Pay 20 Lesser of 60%of the assessed value of the homestead or$48,000. r0-,
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 manufactured home that Is not assessed as real property may not
exceed one-half(1/2)of the assessed value of the mobile home or manufactured home.
Signature of Auditor 2 Date Signed(month,day,year)
\. `{�rj (3 a 0, 1 �� ) Lk— ( l i t -:-
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DISTRIBUTION:Original—County Auditor,File-Stamped Copy—Taxpayer
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