Homestead_Hardiman (19) E�1 STANDARD I UPPLEMENTALDDE UCTIO Y�R
rl?. r.a FOB
li.a SUNFarm 5473(RM1-16) I� HC10
�Rf.,wia i' Presmbee h'the DePHa ertet Lori Goverment Francs
INSTRUCTIONS:See reverse side(wiiingarsb,Wms. OCT 6 2°17 �`��y DULY ENTERED FOR TAXATION
NOTE Telephone,Social Seaady,drivers/cense,stale 6Jere:carton end federal l�Nfficaa'�on numbers are aute�al under IC 14114 17.is i1.
CERTIFICATION STATEMENT . s Lance for transfer
�/�— Y r
I(we) L.curt —1'/,e> ��TJIIai!�7171!'f. i as my(�) „_
place of n is hereby y claimed on the buying the following li de n is si real. ...i rald�ypg. .'' d�mesteapd�Tax Standard
Deduction is hereby darned on ue date this application is Mg .,.. I' r++ ����++ (dare a ' Auditor
❑ Am(are) entitled to occupy as❑a tenant-stockholder of a cooperative contract. Gibson County
cooperative housing corporation. Parcel #
❑ Have a benerdal interest t in the trust or the right to occupy the property under the terms of a qualified personal resid trmt---
❑ Am(are)the shareholder, partner.or member of the entity that owns the property.
_
Cam Towntvp Tieing dIDirl(ray,tam,banhrp)
Parcel ranter tags daSO i `Is the ptwair N giestica .
❑Reg flirty ❑Amenity assessed motile home(IC 6-1.1-7)
II erg;urban of the rasa:WW1 stets.or the lad not esmeotla cur(1)eau Mat iwnedar/s•samnds that stamina coed b mace tax. .Casaba the um awl;craw
of the plOre ty oared b Mara an
a(— l a-D'1 -COI — 00 3. at g—oa 8
....71:-..7:-....-7-- r>:\1±'mss ,'y ,PROP.ERTY,OVJNEDELSEP:HERE aY.CLAlA7ANT '"s- 'T'S.',,,,,„" ; "
SaN,Casty,ad Township Is daaneil vactng a homestead?c
❑ Yes ❑ No
I hereby certify the above statements we bue,correct,and complete.
Athess of email(murtaW street city,stile,aril Z/Pmd+) re eatabd tap W mite(Cary.stab,and ZIDCCd)
02 10 5 . A a k t
u - ASSESSOR USE ONLY f . _. i ASSESSED VALUE. I �HOMES-MAO VALUE i--..-; VALUE
y .:
Land not exceeding one(1)sent humMb ki:F
surrounding residential improvements (1) }_ '_E..., ti'0~.
Total land(line 1 plus line 2) (3)
?;ResT �c`=` rfiy -f '
idential Improvements or Mag Dwelling (4) i ,�''
annually assessed mobile I c big" y
manufactured home rage 5) T.:=-"":41:4_ ..?.r11.5.7.nr
Other improvements (6) t 5't` r`
Total
Improvements(fare 4 through line d) in
Total value(line 3 pas line 7) (6)
I hereby eerily the above is true,correct,
°a Ott° DULY EN 'As-r.." 1 11 ON
and complete.
Vadyay at Swam tc.1:.t'.le Lt iv dal .<..
day `it. -;I— I�i
3 i `{T�SY ri r-TANDARDDEDUCTIONALLOIYA NCE'L's:? ' i1F`7 s-{?,:.7. n.3a_t+_
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000. ///�� I A�
-'I' Mfg -
tdA Or
Notwithstanding any
asother al properly the slap of the deductions provided in IC assessed 6-1.1-12 real amobile home 5 1CT 6crib aunty
that is not assessed as real properly orb value of home(hens not assessed as real pnperi prix 'a
rot&seed one-hall the assessed value of the=te7e home or mmatacaacd home. Lot�r��
Sipaare dAUda/ �� � DaN U®er tM'tA Car, aF�
5y>,CC4a) AALi � r tojD IT0R
DISIRI m1oN:Original Court).Naar,Rosa ped Cmpy-Taxpayer GIBSON CUU�f''
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