Homestead_Farmer (2). �
CLAIM FOR HOMESTEAD PROPERTY TAX � �
i...P�+; STANDARD / SUPPLEMENTAL DEDUCTION HCRO �
Sa:e Pom 56]3 (Po5l Sia)
�'' Presmbedby:tie0epa�.entc!LO�IGwenuneHFranre
INS7RUC71M'S�See reverse side for tlrg ins'vuctuns �
hOTE: Telephone, Sodal Secunty, tlrivers lirense, sta:e idenfticauon alMledeal idenlifiraGOn numbers are wn e,ia/ M IC F1. f 37.
II(VJe) "I�l � certiN Nat I(wel ocwoied as mv (ourl orini
I place of residence or am (are) buying ihe following descnbed real property under wnVact tor which a H�eF:e� �Opp�y�7ax Sari[
DeduCJon is hereby daimed on the da;e ihis applica5on is signed, (LiLe�ot Si2j t� �i�(We): �
L� O++n. O Am (are) buying under recorded contraa. `
� Am (are) en5tled to occupy as a tenant-stockholaer of a cooperetive housing wrporetion. �//(�{/,���
L Have a beneficial interest in the Wst or ihe right ro occupy the property under ihe tertns of a Qu61R�W'¢ n�g} ��.
❑ Am (are) the shareholder, partner, or member of Ne en5ry that ovms the property. GIB$VN C.OUNTY A��1 I V
Na.:ie
en me�a4
Legaldesvip.an
C any pofuon of Ne restle�f I strwure a iM laed
x c�e o�oery v.aaea m u�um inmme.
�m.
I hereby certify the above statements are We, cortect, and complete.
'.CC:ess ot mmaa (�mDer erM 4reet. riry. sta:e. ard 21PmCe)
Lantl not ezceeding one (1) acre ImmeCiatety
surzounEinp residential improvamen6
OtherlanE
Todl IanA (line 7 plus line 4)
Resitlential improvements ot Pxelling
Annualty Assessetl Mobila /
Manutactured Home Gaage
Otherimprovements
Tadl improvements (line 4 through line 6)
Tofal value (line 3 pl,s line n
I hereby certity the above is vue, correc4
and complete.
Ja.ryvg acion - Sgna:ure of NAitw
�
�
�
(5)
l7)
(e)
�
Is
�.� , '.-
�
�
�
_ _� _ " ��_..',
�
u'-���
b ❑/wvuW auessea mooie nm (�c e
o useo m R��'vmne. maiEe me use antl o0
�
L
tla"unant van5ng a
❑ Yes Q No
Q� �
\ �
20 _ pay 20 _ Lesser of 60% of the assesseC vJUe of the homes;eaC or 545,000
No�Alh9arMing any otherprovivon, (he sum of ihe deducfions provided in IC 61.7-12 ro a mobile Mme S
Naf is noqass�ssed as real pmperty w ro a manufacfuretl frome ihef is rrof assessed es reel pmperty may
rrof erceYd ol�haH (i/Ao7Jhe assesspp value ollhe mod7e hame w manWaGUred hortre.
DISTRIBIITION: On3inal - CounryA d:iw, Fde-SampeE Cop� -
,✓pnN.tlag
oa:a i5�a (mdwr. my.
�\