Homestead_Deno (2) ^, CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
STANDARD/SUPPLEMENTAL DEDUCTION FORM
r 11,. Sole Fam son pt17 lt-167 HOW
Rammed by the Department of tones Gc-. rsnme Erm®
INSTRUCTIONS See reverse side 3rErna elsbuckoru
NOTE Telephone,Social Searftx drivers Fcense,state idenlidcarron and federal idenese nn numbers are•- •-74 .i. 1.1- '3 . !.1
w �CEP�.TIFIC�ATION STATEMENT • f
I(t) I In_I I�5�!ellW ._ certify that . -)occupied as my(our)principal
• place of residence or am(am)buying the fg50wing described real property under contract for which a ome egd Pro a Ifs Standard
Dedltdion is hereby da)med m the date this application is signed, I fern).
❑ Own. ❑ Am(are)dying under recorded contract
❑ Am(are) entitled to campy as a tenant-stockholder of a cooperative housing corporation. .
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a quaDt4 ce trust
❑ Am(am)the shareholder, partner,or member of the entity that owns the property. GIBSON COUNTY AUDITOR
-
Canty Toenstip Tmiq&Ma(fly.cowl lont*)
Peed number legal d:sapm Is Me property in gves4wx
❑Rey prawely ❑Amway assessed mode Mme(IC 6-1.1-n
If army oaten al t the redrJaeal=rumen or Re laid not meeting one(1)acre that mxnedatrly t,rra ds that struoaseb used to produce biome,&sate the use mid pram
or Pe property fared b produce®m
_. 101 — 000 . 6-00 ,
. s: v--ri S` r':x . ,,w;P•ROPERTI OWN ED,ELSEVIHERE 9YCCAIMANT _ - [. y- 44:51-
Sono Gouty,and Township Is claimant vacating a homestead?
' sss���aaa4����ee ❑ Yes ❑ No
1 hereby certify the above statements are true,correct and complete. i
et maid(muter at street rip;see and Won/ Adden d vacated F-- .Waal(nasberaedsreer.dh.stab,and Zp'mb)
:6A S. L .
sts
ASSESSOR USE •ONLY ��; A..1• ASSESSED VALUE� . HOMESTEAD VALUE.:-- VALUE•^
Land not weeding one(1)acre Immediately
surrwndRrg resdemlel mpolemants (1)
Other land (2) t'
Total land(line I plus line 2) (3)
Residential Improvements or Dwelling (4)annually assessed assessed mobile I
3.G s " -5 -t a
manufactured home Garage (5) °y.....
Other improvements (6)
Total Improvements(line 0 through line 6) (7)
Total value(line 3 phs line?) (9)
I hereby certify the above is hue,correct.
Signature of Assessor One signed(uadh�J:tea)
and complete.
Verifying anion-Sgnasae orAudtsr Oats skirled(nara%day,lean)
a.n-'E-c' J =` ,r STAItDARD DEDUCTIONACLOtVANC6•-." ,y - , .. ., - -
20 pay 20 Lesser of 60%of the assessed slue of the homestead or$45,000.
Notithslandng any other provision,the sum of the deduction prodded in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or a manufactured home that is not assessed as real property may
not ex one-hal(Mar the assess value of the mobile home or manufactured home.
Ecracre
D6'mSUTION:Original•Casty/u rbor.Fie-Stamped Copy-Te¢eyer
Page 1 of 2