Homestead_Compton CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
' s;.k STANDARD/SUPPLEMENTAL DEDUCTION FORM
-._a,, State Form Said(Rtll 1-16) HOW
!�e_f7 Prescribed by me DepeEnatl•heal Goverment Finance
INSTRUCTIONS See reverse side for fling hrstrucions.
NOTE Telephone,Social Sxwtt driver's license,stale Hm65caeon and federal iderATCation numbers are confdenUal It, r 1.:12-3 ,: :_-
I CERTIFICATION STATEMENT ��
��aL.�I ' � � that I(we)ocaupied as my •I �. ..
place of residence a am(are)buying the following desaaed real property under.. • which a P ax --. :
Deduction is hereby claimed on the date this appGCaton is signed. (dale O ). 1 06)7
❑ Own ❑ Am(are)buying under recorded contract NOV 9 2017
❑ Am(are) entitled to ooaipy as a tenant-stockholder of a cooperative housing corporation. .
❑ Have a beneficial interest In the trust a the right to occupy the property under the terms of a Qtahh
❑ Am(are)the shareholder, partner,or member of the entity that owns the property. GIBSON COUNTY
Taxing • • ,town beeNp)
Peed ncber �l da lm elf) 1_3_5—/3 t. 1'12-0 pRea bpty ohp erp1ay swc
❑A.vvsry mewed anHermm(ic 6-1,1-7)
very mean d the reedemia sowers or the land not exceeds°ate(1)am Mat rani*sanutls that sincere Is used to°wince imna,describe the use and palm
d as Rt4my r s$e d to pods ime
a6- ii- o/ - Yo (l-cod . (48! - 0 „1.. a
_ _. .,e. 374.:1.7 it "-s`._�P_ ROPERTYOWNEOELSEN.4IEREBYSCCAlA1ApT W$,,.',:,rnicr.. --,p p_y.,, _
&m.Carry.and Tonne Is claimant vacating a homestead?
❑ Yes ❑ No
- -d
I hereby certify the above statements are hue,correct.and complete" 1 A 0
dm dad(reran sleet ab.siste,adZlPOpah Address lv homestead,allay(number weet Mx see,andZieccd)
•
I " A . 1 Nib Si., 4 6 / - /
r1ON.RE
'ASSESSOR USE ONLY .• I ASSESSED VALUE e . r HOMESTEAD VALUE I VALUENTJA vin-
aurtoundmegars(I ential reuptoveman� (1) _ ••- - [Y ''S-;4'x 2y Mt
Other land 3 - i -
Total land(line 1 plus line 2) (3)
Residential Improvements or banning (4) - _ - - V t4 -.
annually assessed mobile I
3 j
m
manufactured hoe Garage (5) ,.,"!:.,.. ar:--1'54, . ,. sg 3i
Other improvements (6) W.:? ?�t=3.-_a+r
ae
Total improvements(tine 4 through line 6) (7)
Total value(line 3 plus fine 7) (a)
I hereby certify the above is we,correct, s dAsoessor Pats coned(°°d'1,day yea)
and complete. .
Yoshio°scam-Signature aAndmr tae sgad(era day:sem
iiy.ads---.1+yc e—s,- -2r n---,-emu.-„ -s--,-.--..a+...-rlrraasr s..s
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Nobethstard l g any other provision,the sum dine dedudio s provided N IC 6-1.1-12 M a modWe home $
that Is not assessed as real property or lo a nlamdactured home Math not assessed as real property may
not exceed one-haa(712)of the assessed value a the mobile home or nlanufacaued home.
Sgmbre ptkaamr 1
Ote aped(caee day,year)� / O /
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