Homestead_Langford�
"'^ CLAIM FOR HOMESTEAD PROPERTY TAX FoRM veaa
:_ � STANDARD I SUPPLEMENTAL DEDUCTION Hc�o ,
State Porm Sd73 (R72 /6-09) .
�� / Pfescribed by Ihe DepaMrenl of Lo�l Govemme�ri Frmr�ce . . .
INSTRUCTIONS: See ieverse sida /w filirg inshuc(ions.
I(We) certiy that I(we) ocwpied as my (our) prindpal
place ot r sidence or am (are) buying Ne tollowing described real property for which a H d Pmperry Tax Siandard Ded� i�h�e�imed
under 1raG on the date �his apD���Uon is filed, (date of ng):
(We) own ❑ Am (are) buying under recorded coniract C��•��
Am (are) entitled to occupy as a tenanbs[ockholder of a cooperaUve housing corporation �
❑ Have a beneficial interest in the wst or the right to occupy the property under the terms ot a quali�ed personal rQ�QQ�iQOUNTY AUDITOR
Record numbu Page
Legal Eesviption Is the properry in question:
�.oa U � Real Property ❑ AnnUaOy assessed mWZle hane (IC 6-f./-
s
: WM not erceed"ug a�e (7 ) acre that immediatey surrounes that swaure is used m pmduce inwme, describe Ne use and portion
Twmship
County
I hereby certity the above stetemenis are We, corteU and complete. . `
X
d (numberarMSbeet,tiry,alafe,antlZlPm J) �
�iqSFi E 1Z0 S 4v c�r •
.- .
Land not ezceeding 1(one) acre immed(ately
surtoundin residential im rovements. � �»
Olherland (2)
Total land (line 1 plus line 1) (3)
Resldential improvements or Mnually �����9 (4)
Assessetl Mobik I Manufactured Hwne �a�9a (5)
Other improveme�rts
7otal improvemenis (line 1 throug� line 6)
Total vatue (flne 3 pl�s line n
1 here6y certirythe above is We, cortect,
and wmplete. �
/aifyifg acbon - Signawre of f�udiwr
�)
�8)
Signah�re of 0.ssessor
20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NWKifAstarMirg eny aNer piovision, Na sum W the deduclia�c proindeC in IC 61.7-72 fi a mab�7e home Nat is $
rpt assested as ieal property w to a manuhctuied hrnie Ihaf a nof assessed as ieal poperty maY rwt ezreed
onahaH(fRl d Me assessad rdhre W Ne mobde home wmanulacture0 hwrie.
Sig�Wre W Aud�tnr � 1 . _ _ • .
To-xnsNp
Date sgneE (monfi, day, ysa�
Dale