HomeMy WebLinkAboutHomestead_Lewis (7)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
S_ A, STANDARD / SUPPLEMENTAL DEDUCTION
State Farm %73 (R72 /6-09)
�� f Prescribetl by Ne Deparirtrent M Loml Goverrvnenl Frmnce
INSTRUCTIONS: See reverse side forfil'ug insWCtkns.
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I(We) certify� aqt cI 1(w�ue) ied as (our) pri�pal
place of residence or am (a 'ng the following described real property for which a Homestead Pmperty Pd'�i5t3Mf�r� �1iji�n��Q%�Claimed �
under mnVact on ihe date this pliption is filed, (dafe o/ filing):
❑ I(We) am ❑ Am (are) buying under remrded conVact
❑ Am (are) enutled to occupy as a tenant-stockholCer ot a cooperaGve housing corporatlon .
� Have a benefidal interest in the wst or the right to occupy the property under ihe terms of a qualified personal residence Wst
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Soda� �
Social Seanry numha of daimanCs spouu (lesf fiva dlgifs) Drivers ficense / Identilrafion / Other numDer Issuing Sfate
of daima�rt's spouse (W9 frva dgGS) '
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If Wyinq on wntract, Fee Simple owners rema
RxorEeh office wAere mnhsG is rewrEetl . Record num6er Page
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Counry . ` TownShiD T' is "(t�ity,.(pwn, fownship
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ParcnJ nurMer L "0 � (%� is`Npe ym_perty in questim:
7/ � —� LQ+'�� D�De+h ❑ Aruu�a0y asussed moM'le hortre (1C 6f.1-7)
�II any portion 2sden�lal sWCWre a Ihe WM not exceed'uq ona (1) aae Na[ immediately surtourM�)at �C is used tn protlure Groome, desaibe lhe use and portion
ot Ihe prope to protluce income. cj ��
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Counry Township Counly Towrtship
I hereby certiy the above ststements are we, oortect and complete. Sgriamre ol aaimant �, / / �
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Pddass (numDer and street, dry, sfete, and LPCOCe)
lllD E 60D S ��: .Q�4 � /.t/ '-/7� �/g
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5urroundn rpsiide tiel m�ro emen�diatey (�) ��-igc��v"`��,a`?.aT.,�.'5��r.���it'" fr
�...,:a.��.J.F .�SfPf`C�:��i
Other lantl (2) ..a'�•�`-,f+.^.'.�',.'L.r`,��,#�€�'.� �
7t;.. ; .r..�: �.
Total land (line 1 plus line i� (3)
� Dweliing (4) � �?'�'�� �����""�
ResidenUal improvements or Mnualty +'•- � - -f�+ `�++'S'��`��
Assessed Mobik / ManuFactured Home � }"�, -%'v-� �� �".�,r § +u`�z�"�•
Garege (5) ��s�r�"� C"�"t�'2,:fi��` �iT ^�_'�
OtherimpmvemeMS (8) .'�3','.�� �y:�
ToGi Improvemen� (llne 1 through line � (7)
Total value (ll,m 3 plis lina � (8)
1 hereby tertify the abave is true, cortect, Sigr�awra of Assessor Date signed (month, dey, year)
and complete.
Veif�ing acGOn - SignaNre o(l�dtw . Date signetl (monN. day, yea�
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20 _ pay 20 Lesser of 60% of 1he assessed value of Ne homestead or $45,000
NoMi(ASfaMug any oNer provision, Ne aum o/the tle0uctiont proridetl in IC 67.1-12 fa a rtrobde Mme Naf @ $ '
not assassed as real properry w to e manulacfured hortia Naf ic rrot essessetl as ieal p�operty may rrot ezceed _
onehetl (1R) d Ne assessetl rafueW the mobde hame ormanNartured home.
Sig�Wre W Autlltnr Date signed (monfh. day. laa�