Mobile Home_Douglas CLAIM FOR HOMESTEAD PROPERTY TAX FORM
eYEAR
STANDARD/SUPPLEMENTAL DEDUCTION
; te Sb Farm 5473 fR1711-16) HC10
Ptmvfbed Or to Department or WW2 Cowers=Finance
INSTRUCT)ONS:See reverse side for Sing rtrsbudions. -
NOTE Telephone,Soda)Seal X drivers Save,:fare elvatl5ca5on and federal JCerrtidaSon numbers are contlei ta)under IC 6-1.1-12-37.
I
two certify that I(we) our)
place of residence or am(are)buying the • real property under contract for which a Homeste P Tad
Deduction is hereby claimed co the date this apation is signed, (date of signature). I(We):
Own- ❑ Am(are)buying under recorded contract. JAN 2 6 2018
❑ Am(are) entitled to ocarpy 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 qualified personal residence •
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
Eng i
- - _ CLAItdANT'S INFORLIATION - �.-�-k-v'-i- T`4.r St" TOR
Nar eddr@aar6(lege name)
afga-u a/,) c'
&dad Seemly pander of eaanmcs spoor(fast The deli) Other's tense I Ideni(YNIOn/Otter rumba Of dahnast spouse(6a eve dgim) Issuing Shea
(A)pinstle only iappocaItsspot=des rot have a social manly l u br)
•^L..,F..a-a%`sY_ --�:, a:? +. ,r ya, -ism:}`CONTRACT RECORDED
t bteeg mmtae.Fm Simple omrts halve
Readers o5ce Where tonal S receded Record number Page
ki •
PROPERTY DESCRIPTION-. ii /Ill U 1, _ •
Cushy Township Tat papa(city town loeeahq)
Pend neuter .err,,Legal desssaap�/WJn�IWO/7 /'/ (� Is de properly in __...
, t:/ aC.A-[42_—.r ,/Me%�C.-'f-6 ❑Res'..: soapy arose mottlehore(IC 6-1.1-7)
If any porfm d tb residential since»r ilhet rof(�acc accessing one(1)ate cal b,une6AHy sarpa64 that sbt5ae is •to payee icome,describe ee we and
®
of to Property tamed in;reduce inane.
is0 — yz 8- b si l- 8-00
�"`-PRORERTY,OWNED.EL ELSEVIHERE.BY,CdFIMAh'T _ -
Sap.Caney,aid Toantp Is claimant vacating a'Innestead?
0 Yes ❑ No
Regrow°of claimant '
I hereby certify the above statements are true,correct.and complete. /I !+/,1 p'q_
Address of avatar(reembrad sheet eel.eta,awl Wade) A6Sea or spied homestead,!ay(ramtr ea/she" ,and ZIP cods)
0 i 3./15- �
_ -a ":ASSESSOR USE ONLY v. I :ASSESSED VALUE 3-rI HOPdESTE D VALUE�. I 1 NOt1-VALI NT
UEIA-`.. _ ) ti yjfJ v/ //1
not t exceeding one(t)acre Immediately
a .=2• \4'- /
surrounding residential bnprovemants (1)
Other land (2) ..�-r�..�__._.-__«•_._e.,•,;zc
Total land(Ime f plus line 2) (3)
Residerdial'vnprovemenb or Dwzmng (4) }i. -4 " is re`'r.'j
annually assessed mobile I
manufactured home Garage (6) ? -a
Other bmProvemenl4 (6) _�-.•,-�::�..;. .;{z:.;-:%�....�
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct, SiphEUe of Assessor Des:grad(moth,dry,seal
and complete.
Vtlysig amwh-Signature dAndrbr Dare signs Oran,dry.was)
..f_ iv- �Lp•1"^+.e DA O_111/ err 1171 ' l�P
-�. ,. _; - SL.NDARD DEDUCTION ALLOIVAIC�' ---,-, _ -)sp,,,a >�".X Pr?eT
20 /1 pay 20 f Lesser of 60%of the assessed vaue of the homestead er$46000 I A is-4 'fl
® tlatis msmedahc rte8 dteuductionms thb notasseea rrm) m 5 JAN 2 6 2018
not exceed onehat(f2)of the assessed vale of the mobile home or mvMactasd home.
Signase elAUdbr Date signed(nor*dry,sea)
/-0? kriEltzthr-
DsiRtetrnav:OrgiW-Ca.ay Amaar,ae-Samped Copy-Tapeyer GIBSON COUNTY AUDITOR
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