Homestead_Pfohl A . CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
Fv1 STANDARD!SUPPLEMENTAL DEDUCTION
1-: � Slate Form 54T3(R17/I-16) HOLD
Prescribed by the Ogaavd a total Goverment Francs
INSTRUCTIONS See reverse side tor tang euinKbaa. V
NOTE Telephone,Social Seaaltc dived eeense,state Hu6u`calon and federal cakvr numbers are confided under�61.1�.12J
CERTIFICATION STATEMENT
' I Me) ¢ 4W ' A 'erg Fe I.' certify that I(we)ocwpied as my(our)principal
place of residence a am(are)buying the following described rproperty under contract for which a Homestead Property Sta,,r�td
Deduction is hereby ctalrned on the date this application is signed, (date of slgna}/�re)Y I( e) V 1,
/y����,' ❑ Mn(are)buying under recorded contract
u Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation. Audi e�
❑ Have a beneficial interest In the trust a the right to occupy the property under the terms of a csi _: ,. .�1.:f••
❑ Am(are)the shareholder, personal resit _° OR (J
partner,or member of the entity that owns the property. GIBSON COUt'. f
— _ 3—
- - - - -
Gouty Taenstip Tacky ds4ht(cRy, earaNp)
Pate emir mf� -'
damp= ace property n quest:t
ea pNety 0 Amway messed enable home(/C 6-1.1-7)
II any paten a the resdcria moue or the land not exmeMg one(1)ere Rat Mvne3Seby that Stine S used to protases kmn'tr describe He'as aid pardon
a Or property aIMed b produce loam
270 / 9-/9- /g/- coo 3G7 Qa
30b r. _ s.7- s.i1PROPERTY,OWNED ELSEWHFJ2E BY;CCAIMAN . -
Sae,Carry.and Toarsltp Is claimant vacating a homestead?
❑ Yes ❑ No
5gaire
I hereby certify the above statements are true,correct and complete. ,r - /
Ili Addwaset---• en:lancet fib:see.ar4ZJPord Address or 1_• aai earner an nett c4 Wee,end Zmcode)
lbw me.—is 1 -., ld C 11�C j k cl tilt
~ ASSESSOR USE ONLY _ l --ASSESS_ OVALUE, . HOMESTEAD VALUE_y` HON_R
VALUE hTlAL (
Land not exceed' '. (1)acre immediately — ,4.1x-Tyi- `
surrounding residential Improvements (1) 1'"':%+;i "�i
a1 l
Other band R) `_F'e 6Yfd/-_e V/ds-r;; �:
Total land(line 1 plus fine 2) (3)
Residential bnprovenents or Dwelling (4) -s!` us}j_ __-
annually assessed mobile I € "" - Y'
. 1„�, -- .
manutacbned home Garage (5) pi .
Other Improvements (6) 'l%,?�c:: ..7--5: ..
Total improvements(line 4 through line 6) CO
Total value (line 3 pia fire T) (e)
I hereby certify the above is true,correct. a aAssesse Cate signor(eat t dt%rea)
and complete.
Vaeyia a0on-Sip>SVe of AUGer Data signed(netaa tel:)ea4
e :..M - -s' ,STANOARDDEDUCTIONACLOW4NCE;i -_ _ .� -y-
20 pay 20 Lesser of 60%of the assessed vane of the homestead o$45.000.
Notwithstanding any othey prcdzioq the sum of the deductions provided in IC 61.1-1260 a Robb hone $
Mat U not assessed as real properly or to a maaaacored bane that is not assessed as real property may
not exceed one-hat(//2)of the assessed value a the mobile home or nwudadwed home.
----, , Dale awed Meath. %Oen
57,61- IL.,/ , /YY).,rit, 1/— — i ts
oSTRlaUINN:QigO-County Auditor,Fee-Sapped Copy-Tea
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