Homestead_Goddard r CLAIM FOR HOMESTEAD PROPERTY TAX YEAR I
A' -' - STANDARD/SUPPLEMENTAL DEDUCTION FORM
- Stet Foam 5473(915!5-14) _ HC10
'=� Prescribed by the DepardneN of Local GOVC:rneri Finance
INSTRUCTIONS:See reverse side for filing instructions
NOTE:Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential under IC 6-1.1-12-37.
"R �r , :7._": S. -(, CERTIFICATION STATEMENT -�--•. i--gl i .Y-:
I(We) certify that I(we)occupied ';s y i'1's"nnd•-1.•place of r—idence or am(are)buying the followin• •escnbed real property under contract for which a Homestead '-
Deduction is hereby claimed on the date this app ration is signed, (date of signature). I(We):
❑ Own. ❑ Am(are)buying under recorded contract NOV 2 3 2116
❑ 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 -�L.•-floe trust
CI Am(are)the shareholder, partner, or member of the entity that owns the property. ei
If buying on contract Fee Shnpte owner's name
Recorder's office where contact is recorded • Record number Page
attr ` .;.... �3•..17a Yk l-PROPERTY,DESCRIPTION >=
County Townslrp Ta¢g d¢Tc(tlry,fee+4 township)
Panel number Legaldesai{em //✓//� Its , mquesliai
Oe2A a e_.t3. Jl e.Ci 5 ']Real VOWfy ❑AmuaN assessed noble home(/C 5-1.1-1
It any portion of the residential a tree cc the land not exceedd:3g cnee`(I)acre that e-Ma•.ery surtaatlsrMat is used to Rods ircmrk desalt the use and Prat
of the Property%aired to produce income.
02 (o'02. 3 — / e. - Ao0 - oo )-. Leo _o.l y
.•. -'...PROPERTVOWNED ELSEWHERE BY CLAIMANT _ . , _•
Slate,Coati and Township Is claimant vacating a homestead?
. • ❑ Yes ❑ No
of claimant
I hereby certify the above statements are true,correct,and complete. G I
of cone(number and 'eet a7'.Sate,and ZIP code) • _<of vacated hccesead.d any(number and street,ate,rte.and ZIP code)
•!# 1.. 0 f I-14;-.1;rw\ S1•j rats+act+ 5;1.- 4176 3•ASSESSOR USE ONLY I ASSESSED VALUE I ._HOMESTEAD VALUE I , NON�EASIIDENTIAL
Land not exceeding one(1)acre Immediately
surrounding residential improvements (1)
Other land (2) S__° - -.-.- .vM•0f:
Total land(line 1 plus line 2) (3) - - _
Residential Improvements or Dwelling (4)
Annually Assessed Mobile I
Manufactured Home Garage (5) . ..,2- - . • -
Other Improvements (6)
Tolal Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct,
ofA=•'<•nr Oats signed(ncnth,day,veer)
and complete.
Ve'Yyvgaeion-Slgrahrre ofNdtor I day, ,ar)
Mi
3;r- -'�=.ZMr- •STANDARD DEDUCTION�ALLOWANCE� ' �dFat:
20 pay 20 Icccnr of 60%of the assessed vale of the homestead or S45,000 3
Nolutths'andurg any otherpmvision,the sum of lire deductions provided in IC 6-1.1-12 to a mobile home $ NOV
2 3 2016
that is not assessed as real property or roe manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Signature Aud.or s (Si _ e / �
t se>1-.w� /� aIBSON COUNTY AUuI l OR
DISTRIBUTION: Ongial-County Au&or,File- tamped Copy-Taxpayer