Homestead_Lay CLAIM FOR HOMESTEAD PROPERTY TAX
YEAR
STANDARD SUPPLEMENTAL DEDUCTION FORM
HC10
� 3
Prescribed by the Department of Local Government Finance i
INSTRUCTIONS:See reverse side for filing instructions.
�•srap- ;r= .S�:ii rW .'�3-tr FY vita k4 rr j SFa
.-aW. �ts •�,"� �,+jF^� CERTIFICATION ST�EMEN�q'�r;Riw�E�@SyteF:py .1. iy 'Sti., -_i�.,R.�,
I(We) ^����•�`���V]�TS• v" Ty the (we At •7 a Al •'our)principal
place of residence •'m(are)b. ;rig the following described real property for which a Homestead Property Tax Standa Deduction is hereby claimed
under contract on the date this application is filed, (date of filing). I(We):
4. - ❑ Am(are)buying under recorded contract GIBSON COUNTY AUDITOR
II 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. mss,
•-"rte gi 'Ji,` '. 1?_"y�.�nN''- .a'-""s"°�" =s > .'` • .u`ns.°" N 17ill v:
ra.u,zy,_,d,.�f>r3N•+.li„n,.e�..a'.teF'kpe.a�•'� �,CLAIMANTS I�FORMATION,. �aaidal�'c.s• y,
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page
. �xrk ..R o Sd a0:miw zi �ar2its.,.._y-.P�RO�P,E�RT.e�Vj+f].ESCRIPTIOeN�is�”s•``.^,���i. y r.�.�aJ.F.dg.X ir$,.,�..9.'��v2.:%-t�-c_n�.:a_ .:�#�h
County Township T ' district(cit town,township)
Parcel number I Lj Legal description Is the property in question:
/eA. • ,a• is Pit,al property ❑ Annually assessed mobile home(IC 6-t f-7)
If any portion utilized the id produce ccomo
residential str or the land not exceeding one(1).tie that immediately surrounds that structure is used to produce income,describe the use and portion
of the property
""-`"' The 'r& <�' .: 'PROPERTY OWNED By CLAIMANT IN OTHER COUNTIES ? r i476;c g- t
`. x�'.�a.. izTa=fe::...-� e�,s�'tii��.�. I.E_. _ � J. - 3� `+3�" „`Y`f_-_...�.n�-Sa$'an- �Ng
County Township County Township
I herebyr,/�: e l
@u pv T-aare true,correct and complete. Signature of claimant
Address(n rend street, //•, -'• P code)
3 E • .t� U 1 15 a`T
,�--. ^`�"�� "' �g twaltg yc"-t.'wyTt -W n . ^`. r_-itc are sED VALUE Lxsv`'HOMESTEA61,5t {NONcRESIDENTIALf'°zti"
1 t ASSESSORcUSE ONL R !s�'IE�TRUE TA%,VALUE}ITi ocroYOF�T.T,Wi VAL•UEu�' 1t VAL'UEt'F>a :?Nst't-`
Land not exceeding I(one)acre Immediately (1) '..
surrounding residential improvements. - - - - -Other land (2)
Total land(line 1 plus line 2) (3)
, t 2! Y..
Residential Improvements or Annually Dwelling (4) 1
Assessed Mobile I Manufactured Homo age (5) 1 c '
Other Improvements (6) `';til:
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
I and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
cc Tertg 'gin UVaiil W' WiSTANDARO DE 1irci ON AL•L WANCE� '+`'`.' atZ,S . :Aaft s'it l?;
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-f2 to e mobile home that is $
not assessed as real properly or to a manufactured home that is not assessed as real properly may not exceed
one-half(12)of the assessed value of the mobile home�orm)manufactured home.
Signature of Awd; c3/t`r- r� Date signed(month,day, r)