Mobile Home_Hicks ,ci CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t cfl STANDARD!SUPPLEMENTAL DEDUCTION FORM -
, JL S1ateFam5a73(RITII-16) HMI�j Prescribed by Cu Oepsa+va of focal Covarerat France
INSTRUCTIONS:See reverse side for king esNekans .
NOTE Telephone,Social Setoff%*Ages Cxnse,state and federal Ide�cffi numbe
rs bers axe cold*tar under IC 6-1.1-12-37.
® I Mre)_ (f 47 . • certify that I(we)occupied as my(our)principal
place of residence a (are) the following desoibed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed an the date this application is signed, (date of signature). I(We):
❑ Own. 0 Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy 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 quaffed personal residence trust
❑ Am(are) the shareholder, partner, or member of the entity that owns the property.
Seal Seoaey number of clamant wPae.(b4 iea&Phil Diners Xa®/leeai.5t'dbn beer amber elclacfines spouse(led the rig 2S Using Sate
!II(AJpPmble ady✓entrant's apse.Wes nal have a sorial seardynrmber)
▪ 4;�) i.,-.q23:-'...oca .`.+- ..tiamtl:rfyr( Yala7iled 1 i. ..za N." - ..1111_..
II laetg on caae:t Fee Svcpta anus here FILED
Reoft, dols dris oft,ahem ro receded gt••a, p,nutter Page
Catty Tawelrq Taag dstid(cry,r vet Seats)
Pater'.mbar Le"desaV" IIf4i j Is we poputy F aeseaa
GIBSON COUNTY AUDITOR ❑Radprapedy 'nary massed;noble ho e(lCdr.i-T,
a erg baton of we residerviaf drogue orbs lard not ccawing one(1)acre eat irtonemately arrant that stricture is used s pro /eon .deeate eV ice and Paten
® of as properly caned to lmdre bane.
aio- 4a 1 ' -osb 11 - OD . al
.._ PRs-—TY.YN. T—YH'" .Y~AIh'A\T '-,¢Tp_.-��, T''.?-.
Saw,Coady,ad TaveoS - _ . . . - - -
Is claimant vacating a homestead?
0 Yes 0 No
0
I hereby certify the above statenmlts are true,correct and complete. r �� e ,
---� .mrtad(rw'beradstmet co%,state,and LP rude) �jy -rp Address of harestad,if art y prahbaard sewed ay,awe at Woods)
2-5 .F,e'de-- - 1--4-7 si
_r ;;ASSESSOR USE ONLY _. ) ASSE53EOVALUE, _' - HO71ESTEADVALUE 4 _I NOII-VALiUENT1AL-___'r-
LendnM11notqreesld.ntial (1)eding one 1provements acre iately (1) 2T_.T�� .�.,ti
Other land _,?
Total land(line 1 plus line 2) (3)
t .-,a,3 w r -_
Residential mends or Dwelling (4) - ._ ,��?<.-_i iS
annually assessed mobile/ _ -
ra
manufactured sh x _uredhome Gentle (5) z '- - rr 'ems
Other improvements (6) e i.+ '.: ..v J ..n
Total improvements abed 4 through line 6) (7)
Total vahra (line 9 plus One 7) (9)
I hereby certify the above is true,correct, S ofAssesw Data signed(nanny mx Peak
and complete.
Waaigg acian-Signalize SAutor Date shed(madly dry,leen
'•(� - - cSTANOARDDEDUCTIOUALLON/ANCE r.. ' '^• -`:
20_Pay 20 Lesser of 60%of the assessed value S the homestead or$45,000.
®
Notafhstandog any other provision,the sum oft the deductions provided in IC 6-1.1-12 to a MONO home 5
Nat is not ssessed as real property or to a mamAatOted home Maths not asserted as real properly may
roterr (1/2)ol the vabee of the ntbde horns or naaPut)
nzzdaraa rid home. �tl/psd fly ylJ�(�'p
Spared prf a ) Doti _(�ml V
vt:thin
DISTRISU11ON:Original-CarryAaLb,Fee-earyed Colp)-Tacna A,1 `�/l/ ♦ 44VV
Page 1ot 2