HomeMy WebLinkAboutHomestead_Parker (3)•"'" CLAIM FOR HOMESTEAD PROPERTY TAX
,_ STANDARD / SUPPLEMENTAL DEDUCTION
°� stateFOrmsa7J(Rtz/6-oB)
� � Prescribetl �y ttre DepaRmeiri of Lotal Gm�erm�eM Frence
� INSTRUCTIONS: See reverse side /orhTug instruc(ions.
FORM YEAR
� '
I(We) t C1�.�CJ�-�' certify th'dI i'(We) �'ed�my (our) prindpal
place of residence m(are) buying the following desuibed real property for which a Homestead Property Tax Sfandard D cti hereby daimed
under contract on Ihe date this applica6on is filed, (date oI filing): (iIBSON COUNTY AUDITOR
❑ I(We) own ❑ Am (are) buying under recorded conVad
❑ Am (are) enlitled to ocwpy as a tenant-stockholder of a cooperalive housing corporztion �
� Have a benefidat interest in Ihe Wst or the right to occupy ihe property under the terms of a qualified personal residence Wst
•• • •
3me damunt(kya�name)
���/ �
SPW�
If buyuig am m�4ad, Fea Slmple ameYS �ame
Recordets oftice where mnbaU is recoideO
Caunry
of daimant's spouse (last77ve dgifs)
Tavnp distriU (U}: Mwn, fownshiG)
Is Ihe pmperty m quesfion:
Remrd numhel � Page
�.7'3:5 '�UU "`U�U • d�lOU 1�� � 1 I LJ a�t v�cem LI AnnwOy assesseE mohile home (IC &1.7-:
tl ary portion oi Ua restlential svucwra or Ne land nol essed4ig rne (1) aae ihat mvnedatety wrtounds Ihat structure is used b pmdum imm�e, desmbe 1he use aM portion
ol �he prapefty uti0zed tn 7mduca incoma.
P�Sur 33-1"�O '�•��
-.- . .: . .
Counry Tamship County � To+mship
I hereby certify ihe above statements ara We, mrred arM compiete. �"H °�""a"� 1/% �//
h 7
Pddre (number end stree4 �+N. slale� and LPcade) (� � p • / J-. � 1�� �
� IftRZ A] �tt�'�'�PfS �U%i i�ItiGCTOh �
LanE not ezceedUg 1(one) acre immediatety
surtounding residential improvements.
Olherland
ToUI land (line 1 plus line n
Rnldentlal improvements or Mnually �Iling
hssessed Mobile I Manufactured Home Garege
Other ImprovemeMs
Total ImDrovemenis (llne 1 through line 6j
Total value (line 3 phs line n
�I hereby certify the above is We, cortec[,
and wmplete.
Veilying actim - SignaWre of P�car
(3)
(4)
(5)
�)
(8)
SIg�Nre af Assessor
20 _ pay 20 _- Lesser of 60% of the assessed value o� the homestead or $45.OW
NotwitAsland'rtg eny olher pioeivon, Ne sum o/fhe dedccfions providetl in IC 61. f-fI m a rtrobde Irolrm Nat a
rpt asmssed es real propeily w lo e manu(actured Ironq Na( La not essessed es real propeAy mey raf exceed
arehaM /1210/ fhe essessed rdlue d fhe mobile hwne ormanularlureU Mme.
a a,a�wr
$
Date signed (month. daY. Y��)
Date signed (mmN, daY. Y��