Homestead_Keil CLAIM FOR HOMESTEAD PROPERTY TAX PDR6! YEAR
4.rie . STANDARD/SUPPLEMENTAL DEDUCTION
PrescnOr 5473(R17l me) HOW
PresoSed b the Oe{mtaav of Lire Government Franca 1
INSTRUCTIONS:See reverse side talks?6rsfi/dwts. - i 1
NOTE Telephone,Social Securt(%diver's kens°,stateden',rrcdon and federal i ntZca5m numbers are....... , -, .
��1f. ���� CERTIFICAi1OONNSSlTITEMENT„ p
I Mk) ,�I S�4\�.orris.� �� ne81 I certify that I(vie).;... . .. :. (our)principal
place of residence or am(are)• u. I ... • descried real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on • - - , application is signed, (de of Skgnner ).
❑ Own. ❑ Am(am)burying under recanted contract ` j (i i
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporatIG3IBSON COUNTY AUDITOR
❑ Have a beneficial interest in the tout or the right to occupy the property under the terms of a qualified personal residence tout
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
(
•- . - .
Canty ToeaNp Taxing detect(cry,bed Mendip)
.
Prat
t runner Legal afpgen I is Mc PWaty In atestionr
❑Reel pvpeny ❑Annually assessed cootie tram(IC 641-7)
If cry portal ci the re5 down athe bad not eY6ethy ore(1)acre ear bunecst ysnzts that structure is used to produce Scan,describe ere use end caul
of Ihe property imbed to produce bone
(o -DO -3l - 40o - 00o --l1 5-001
7 r_- h.�a.'Y,PROPERTYOWNEDELSEPAiE2EBY.CCAIhiAhT-Z ' .. '._. ..�
.c.cu e' W Is claimant vacating a homestead?
❑ Yes ❑ No
Sumse of derive
I hereby certify the above statements are true,correct,and complete.
Address at contact(nether awl:beet,db stab.and Womb) Adtress of nosed brassiest dab(number de Meet,Mg Sat.end ZIP cote)
/034 S . ' • 5' s - t to r r`
• ASSESSOR USE OCILY 1 _,�_ 1 ASSESSED VALUE:_ a r,HOr.1ESTEAD VALUE :i NONRESIDENTIAL .-`1
Land not exceeding one(1)acre Unmedietety Yi ( y<`
sudoundmg residential improvements (1) 1�� �++c .-..-
Other land _ . F 4--t >:r`
Total land(line 1 plus line 2) '(3)
Residential improvements or Dwelling (4) - +yo-,- e - --r'I
annually assessed mobile I _
p tsn s:X.
manufactured home came (5) _ r..j,,g.:...,�..x-i .M.dal:t:
Other improvements (6) /'{"' 1:':Y1A
Total improvements(line 4 through line r) (7)
Total value(fine 3 Os line 7) (8)
I hereby certify the above is true,correct, '+°°dASSessa Dab signed(me;tip:wan
and complete.
Vettg titian-Ware dal6b Dab signed(motet,day,lee)
'rnr. 77:7 77 't'•-l- ? r'}:_STAI:DARD DEDUCTIONALLOVIANCE ^= '- ,;_,--=+
20_pay 20 Lesser of 6096 of the assessed value of the homestead or$45,030.
Nohod hsbnGvq any other provision,the San of the decr:Owts provided in IC 6-1.1-12 to a mobile home $
that is not assesse4es real property or to a red home that is not assessed as real properly may
notexceed 1/2)of the assessed vale of mottle home ormeudaadured norn.. �{/�p/)ge.O 1
SigmuedAud# ...
/e( , 1 1 1_
DISTRIBUTION:Or%is-Cantymeld FeeSfarped Copy-Tate _\ w
Page 1 of 2