Homestead_Buck N_ CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
• STANDARD/SUPPLEMENTAL DEDUCTION FORM
Seta Fam5473(R17/1-16) HC10
Presorted by ties Department of Local Goretmen Fiance
INSTRUCTIONS:See reverse side for tiring a sU uctont
NOTE Telephone,Social Security,&freest Ecense,state ioenUca:ion and federal iderdslcaffon numbers are an6dautal under IC 6-1.1-12-37.
,f'� CERTIFICATION STATEMENT -
I(We) J'C_.�S•\C—n._ - Ltc - certify that I(we)occupied as my(our)principal
place of residence or am(are)trying the following desaibed real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this app6catlon is signed, (date of signature). I(We):
I t4Crt. 0 Am(are)buying under recorded contract •
❑ A.rn(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial ihitsest hi the bust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partneh or member of the entity that owns the property.
e&yew an mead,Fee Simple armors name
Recorders ogee where mrnat is receded Read number Pepe
Casty Twfl. Tsang laid(rot:town,township)
•
Pare armor lagd n •ila Me peopatyn question
❑Real acpexty ❑Nmm@J essayed motile law VC 6-1.1-7)
U any portion of the residental saumse or the held not exceecing or(1)we as in:nadzab nen:A ds that router is used b mom ere,denote be the aid parer
of ttw property aced b pare:nee.
\ CI- \ co - 030 .
. , :Twopenny OV/NED ELSEWHERE BYCLAIMAt:T : _ • c
Stab,Casty,and Towmhp Is claimant vacating a homestead'
0 Yes 0 No
of clamor
I hereby certify the above statements are true,correct and complete. e a ',�R IL
Address of asfm(mrmba end anent city,a and ZIP dude) el vacated haeeabd, am(mother end sheet.city t.and ZIP code)
K ' SI •c-IACOOon 41� - - • I •
`ASSESSOR USE ONLY I. :,ASSESSED VALUE - HOP-tESTEADLend not VALUE . I - thON-RESIDENTIAL
VALUE
one
acre Immediately
s m:mad-m exceeding
improvements (1).. �2 cw-YZ-spgmfry-�'`vpgpy��pp
Other land A (3) ld--/ A✓
Total land(!rim 1 plus the (2)
���ttt
rteai Dwelling (4)
m dlatnprovemeerts a
annually assessed mobile l ut3
manufactured borne Omer (5) °s-...NU
Other improvements (6) aVit"LJ T:t `
Total Improvements(lire 4 through line 6) (7) Ai"
�/-.1 ,t s
Total value pine 3phs nue7) (R) GIPSONN 4C�OUNTY A ;DITOR
I hereby certify the above is true,correct She CIAssessor Oat*geed Wan.day,)ea)
and complete.
verifying anon-Siwraare cAdbt oar awed(mortis day,wow)
. _-. .-. . .. . -.STANDARDDEDUCT1ONALLOIYANCE C', - '"
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45.000.
Notuithstandmg any other provision,the sum of deductions provided In fC 61.1-12 to a mobile home $ •
that is not assessed as real property orb a manufactured borne that is not assessed as real properly may
not exceed one-had(1/2)of the a ed value of the mottle hone or manufactured frame.
Psndbr Dos signed(nth dry,
-al -, '
WSTREIUMON:Drip'val-CortyAdta,FieSarreal Cagy-Tzothan
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