Homestead_Cash �A� CLAIM FOR HOMESTEAD PROPERTY TAX
.1 t STANDARD/ SUPPLEMENTAL DEDUCTION FORM r A2
HC10 9
INSTRUCTIONS See reverse sde for filing tnstruct:ons
NOTE Telephone.Social Security,driver's license state identification and federal rdennBcation numbers are confidential under IC 6-1 1-12-37.
CERTIFICATION STATEMENT
•
I i1,Ve ► cert fy trat I Ihelc,ccup,ed as my'ot.r-prrcipa'place of
reed rce or a- a ?buying the fc"c:: 'esc- s1 rip-► ' - a s'=r a Ho"estea3 Prcper-y Tax Standard Dec' s ne cy c'a"ed or;he
da .h s app cat cr s sgned G -_ __ a._ .._
NI=- a e ect,tied to occupy as a te-a'S . _ _ _ _^eat.= c_s-g. :c_"a>c^❑' -.c a ce-efc:a•interest it t . .>.• - _ - • _:.e- e._. s.`a q�- -e___s:-a cs.._ ce'_st
0 - are,the shareholder,parser Or memce-of:re t,Vat o:'.rs tee properry
.f Buyprg or Contract Fee Simple Owner s Name
Resc^ders C`f ce A*ece Ccrtract s Recorded Reco,o"tarter 'age
PROPERTY DESCRIPTION
roar`; Tc+ (-2.--- --o. --__
Ste. O
°a-ce`.,.r-oe- 1 Legal 9esc'lpt,or =-ce^.y r;.estcr
=eat o one^y ❑Art^.aly Assesied hone!-re 'C E-•+
a^y co^.c^or tie resde^ta'stroct,.re se the'a^,d rot eceed rig ore'1:acre t . •. s eat s•_-f •e s-sea tc c-tme.^come desc,be the.se a^d port cc
Ole p'::e,.t _ rcme //�-�)
6 . 2 - 9 /� 002 2 � � 0E502 ,,
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County.and Township ��'///���•••///���t� -:3-3- .3'1.-'----• "33^
I hereby certify the above statements are true correct and corr.':-•- / 1
Acd-ess:'Scr'act,r.;,mber and-tree' .-'• - -f.3ra•e i _ 'se r tt, .raer arts _' .,r u 3 __ ..
01 WitS'o S n Igrvl - - 1 -uT-_ 2 y
ASSESSOR USE ONLY ASSESSED VALUE I HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately I(1l
Surrounding Residential Improvement _
Other Land12' ----'Pi
. Total Land(line 1 plus line 2) (3, 44,
Residential Improvements or Dwelling i t4;
Annually Assessed Mobile I -- — ��,r
Manufactured Home ' Garage 'i5
Other Improvements i(6; 4'9,4
Total Improvements(Line 4 through Line 6) ", ON
-- — COLA.C��J/
Total Value(Line 3 plus Line 7) 6' H7'y �.4r`
S,_ratre o'r-ssessc- Cate S g^ed;Sate -or•r 'pp it
i I hereby certify the above is true.correct.and complete. ,T�
_ R
Verfiyrg Onto -F.g^at-a o`Auo tc- — _ - - - -- Gate S gred date •r-rt- ,,e3
STANDARD DEDUCTION ALLOWANCE
No6:rRstanding an,otner prop.-s,cn ^ - -- ..__ _ __ - ' - -
4s not assessed as real propert/ __- '-."' .,' ` < - . '- --
erceed ore-hart 1,2)of the assesses.___ _ -
—__-
,Sigratc'e of A.adddorr� r � Cate S d mph' lay'ar ...
DISTRIBUTION -, g-r al ._. , ..•. _•, -,c-s,e' •
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