Homestead_Richardson (6) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
ra-S..ife. STANDARD SUPPLEMENTAL DEDUCTION FORM
--Li. Sure Foal sirs r-1N HCIO
Proscribed by the Degenment cif tozeIGevernment Force
INSTRUCTIONS:See averse side br Zing instructions.
NOTE:Telephone,Sodal Securitg ddrer's kense,state iden6Sce5on and federal Identification numbers are coati:Praia,under IC 6-1.1-12-37.
I Ntle) Clit.A.le y that I(we)occupied as my(our)principal
place of a am )buying the foliating descMed real property under contract for which a Homestead Property Tax Standard
Deducbon is hereby clal on the date this appbcabon is signed, (date 01 signature). I
O Own. 0 Am(are)buying under recorded contract
O Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation_
O Have a beneficial interest in the trust or the right to ocarpy the property under the terms of a quaffed personal residence bust
O Am(are)the shareholder, partner,or member of the entity that aims the properly.
; • '
Cann Tama* Tsang trAct rots Aiwa(CO)
asitt..aliactr
Patel rumter Legal dasainion
I is liAnetY cluiStiat GIBSON COUNTY AUDI OR
L4 Red Orr ID Annuals assessed mottle home(IC6-1.1-7)
II any parram off.rainwear tructre or the land not excerecthg one(1)acre that anmedidely suntan&that sambas is usedto produce Scorns chrecnbe the use and sorban
of the progeny robed to produce Occrca.
a (0 - -I a 4C0 COL 1-101-0a
- -11c7:1,17:17;r;.1'.:
Stare,Cooly,at Tasmania Is claimant vacating a homestead?
• Yes 0 No
Ststxed X -'
I hereby aatify the above straments are true,conect and complete
•.,„of cursed(nureter old street(*.state and Wee(*)
9 X 6 lf -
A in. /1-4, s &iv", •el f
X5-y.I; _A Se• A cm •t. .,H . in u _NON • SID NTIA4.
I . •
Land not exceeding one(1)acre bnmediately cl..,-,7,4•".4.‘175-7•Ttn.T.(295: s4
surrounding nemential bnprOVeinttntS (1)
Other land
Total land(line 1 plus This 2) (3)
Residential trnproventeols or ()waging (4)
annually assessed mobile 1
I'it'T-RT-TV/T,"RC`-'st'ar:Lr,t;a4,ezt,:a
manufactured home Garage (6)
Other improvements (6) r:ATR6;:kr-.4-X,7-4-14r•T=rzo,C99.7c1 •
Total improvements gine t through line 6) (7)
Tote value(iine 3 pits line 7) (8)
Sigrature of Assessor Dale signed(mak thy yeafi
I hereby certify the above is true,correct,
and complete.
Verify:ye action-Signature crf Audio, Date Ogled Orasak daY,Wag
20 pay 20 lesser of 6096 of the assessed vdue of the homestead or$45.000.
Notwithstanding any Other provision,thesum of the deductions provided in IC 6-1.1-12 to a mobile home $ •
thatecis not ass r reffperrope erty or to av %%toed Inane that not assessed as real property may
not Signature cr Data Riled Imerdt Yoa4
PL.) /0 -s-ill
DISTFSBUTION:Qigind-Carty Aultr.Fibs-Surthed Cy-Tawayer
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