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Homestead_Page (2) A°- CZ- CLAIM FOR HOMESTEAD PROPERTY TAX FORM I YEAR STANDARD/SUPPLEMENTAL DEDUCTION Stab Fan 5473(R15/5-14) HC10 Presmbed by the Depar::em of foal Government Finance INSTRUClONS:See reverse side for tiding instructions NOTE:Telephone,Social Severity,diners license,state identification and federal identification numbers are confidential under IC• 2 �L•.'W^` ,- : .-.., - �'•-ERTIFICATION STATEMENT 'a. '..•"°"' ' ' - '! "T• I(We) . 3 /i_. certify that I(we)occupied as my(our)principal place of residence or am(are)buying the following desc 4_.real property under contract for which a Homestead Proper $�ndard O.e Deduction is hereby claimed on the date this application is signed, (date of signature. e) LL U ❑ Own. ❑ Am(are)buying under recorded contact ❑ Am (are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. , ' (�pe� ai �4 •.eb ❑ Have a beneficial interest in the vest or the right to occupy the property under the terms of a qualified cif , M-pce, ..-4 ❑ Am (are)the shareholder, partner, or member of the entity that owns the property. lJU •UDITOR ` • If buying on contract,Fee Simple owner's name Recorder's oDce where conned is recorded • Record number I Page I1..:ss 11`''..'',x'.'•°-1:;7.fr' P.ROPERTYDESCRIPTION:P� g6'evF'�_s.- �n--�`•_,:_:,; - oerscY Township I Tsang d ' (nly,lox towrst*) Parcel number legal desmpiion Is the property in ques•..t ❑Real progeny ❑Annually assessed nebde home(IC 6-1.1-7) If any portion of the resideK:al err" or the land not exceeding ore(1)acre that i meda•.Ny=Cs that s'.rucfiae is used to produce income.desmbe the see and prelim of the property utfb d to product income. as - l3 -a4, _ (-too - 000 . € 99- oo6 -t-... ' ,_1 - . - PROPERTYOWNED ELSEWHERE BY CLAIMANT . Saab,County,and Township Is claimant vacating a homestead? . • ❑ Yes No Sig,4' claimant I hereby certify site above statements are true,correct,and complete. X ;Address of conDcl number end SOW(p060.5ab,emend ZIP C/J�/•K'4 NC` s TT of fed tmes:ead.d am(number era rGy.She,arM NON-RDNTIAL SSSOR USE ONLY - 'r• -ASSSSED VALE I- , HOMESTEAD VALUE•- VALUE Land not exceeding one(1)acre Immediately surrounding residential Improvements (1) i . ._.: Other land (2) Total land(fine f plus line Z) (3) I — —.- Residential improvements or Dwelling (4) 5-'c, -S-ck,_r S Annually Assessed Mobile l a Manufactured Home Garage (5) s i-.: �_7-6:a){-1 • Other Improvements (6) _,s _tji Total improvements(line a through line 6) (7) I Total value (line 3 p/ls line 7) I(d) I hereby certify the above Is true,correct, Signature of A•�•or Dame sigma(anti,day,year) and complete. Verifying scion-Signature of Aa rer Date signed(north.day,year) • e'r1 '.s, STANDARD DEDUCTION•ALLOANGE F= �T° xj g, l ,= i 20 pay 20 I ecr of 60%of the assessed value of the homestead or 545,000 - - cc tea Notwithstanding any other provision,the sum of the deductions provided in IC 6-1.1-1210 a mobile home $ APR 5 2U16 that is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-half(If)of the assessed value of the mobile home or manufactured home. Signal -of Audam Data signed(race day,yeas) L!IL_"/fa a _ -- I.1's .aiiii is:i/ DISTRIBUTION:Or9nm-GauaYAUdds,FieSamped Copy-Taxpayer GIBSON COUNTY AUDITOR