Homestead_Hobson , CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
es. "�:5 STANDARD/SUPPLEMENTAL DEDUCTION FORM
Sate Fam 64T3(Rtnr 1-16) HOT
Resmbed by ea Deloarox of teal Goverment n Fi®xe
INSTRUCTIONS:See reverse side for Ong cease,slats I
NOTE Telephone,SodaSenrftz threes Novae,state kle.naW:M and federal)Cere n number we miS$ffia/under IC 61.1-12
m_ I i
CERTIFICATION STATEMENT
I(We) /�I.11!•7 . / _vl certify that I(we)occupied as my(our)papal
place of •- .-or am(are)buying the following.--. .:.real property wider co UM for which a Homestead Property Tax Startlanl 017
Deduction is hereby claimed an the date this application is signed, (date of signature). I(W�L 1 I
® Own. ❑ Am(are)buying under recorded contract
❑ 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 residearred
❑ Am(are)the shareholder, partner, or member of the entity that owns the property. GIBSON COUN FY AUDITOR
"
•
Carty Toeetip Taaig dbaid(bay, oelatyp)
r,,�
Patel rata lend de:ub-as � Its the Npmasmrc
Pi IV/U JW /2- Z-I/ ( _We'Revaty ❑A.-nary assessed=tie home(tc&r.l-i)
Ir raw parts of ea r seer tat encase or Ire tad rot emedtg one(1)acre eat Immediately onuses eat sm:Eweis used b nuance mono,decree the use and patio
or ma property ulbad to poets loom.
aLO-aa -/ -306 coo. 0-Se 9 bay
_?_PROPERTY-OWNED ELSERHEREBYCEAIMANT v ._ - 7t-'
Matt Cry,and Teem Is claimant vacating a homestead?
❑ Yes O.No
I hereby certify the above statements are true,erect and complete.
y.SI Ali i .,� .�
Address dcoact(water end street dlr.see ...21P---. • Address.— 7rr- ---..dew(nrasber ertdabem,atty.sta.•a.and ZlPede)
1/700 /So kJ • • " •— L
ASSESSOR USE ONLY ?ASSESSED VALUE ...,,_-:HOMER.
OMERTEAOVALUE - (4Otl V49UENTIALy':':
Land not exceeding one(1)eye Immediately s .5° - 1
=
surrounding residential improvements (1) . -2`: --_ ?iti -r
t -
Oder lane
Tod land Vine l plus tine 2) (3)
Residential tmpromnems or DweOing (4) r5-r. -l u r F -.#--_ti
annuany assessed mobile l "
s -
manufactured home Garage (5) 'r.._-.__.,_ r._ -
Other improvements (6) i _.Z ' ,'
Total improvements(lute 4 through lime 6) (7)
Total value (line 3 pins line 7) (a)
I hereby certify the above Is true,correct. SI9»ra 0/Assessor Date signed(dcrtq dux yea)
and complete:
Vadyig action-&gnaw atMUSta Date signed(tn*day,lead
- '. . .. STAr:DARD DEDUCTION ALLOl•JAWCE-_"--r' - _ _
20 /7 pay 20 I k Lesser of e0%of the assessed value of the homestead or$46.000.
NoMfthstandi g any otherprmfslon,the sum of the deductions provided N fC 6-1.1-12 to a mobile home $ •
Mat is not assessed as real property or In a rnanufamtred home that Is not assessed as real property may
not exceed one-hem(Mot the assessed rate ol the ruble home or mamdacaaM home.
aAama [p P Date signed(=tea dal,load
1�AS7.7...1 9-1-17
DIST fTION:Original Cumrwaa,Re-Soaped Copy-Tawayer
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