Homestead_Pohl (12) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION w�
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INSTRUCTIONS:See reverse side for5&g nsbvcbons Irt
NOTE Telephone,Social Seaaibt divers'tense,state ides and federal Werfficahur numbers are contderbal under IC 61.1-12-37.
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1(We) Q/1 q'4OQ • certify that I(we)occupied as my(our)principal
place of residence or (are)buying the following desatbed real property under contract tar which a Homestead Property Tax Standard
Deduction is hereby ' m the date this appriarbon is signed, (date of re). I
0
teOwG 0 Amn(are)buying under recorded mntrad. GIBSON COUNTY AUDITOR
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Rave a beneficial interest in the bust a the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
unload Gaga//nen*
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It!yin;al=Vat Fee Sayie cents name
Remrdels ogre where meted is amedad Read reenter Pape
• ' PROPERTY OESCkIPTION'- . '- - -
Casty Towaskp Ta3g child(dry,taw,tan 140
_Pace meat daa.•eem 3' / L.�J�
I.7 7 *Were in �aa
Wb9
z/_ :2 /O Red prgwry ❑Acv¢oPY assessed moHa rare(IC 6-1.I-])
It any cation al the reedertal stramre ace land notrt erg ea one s butrJinme62@y vvmn&but atumiaa used to pm®vmme,amaae or the end piton
obe pmpaty tamed m parka loon
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- - - . - PROPEATYOWNEOELSEWHERE 6YCLFI6IANT- .- v '. 5.Gate,Carat rid Tom Is claimant vacating a Homestead?
❑ Yes No
Sipsare of claimant
1 hereby certify the above statements are true,correct,and complete.
Address of cooed(number err entet city,s2..,and ZIPmr) Address of metre haunted.denyfewer and stag,oty:Sate,and ZIPatde)
'-ASSESSOR USE ONLY < ASSESSEOVALUE HOt.ESTE:.DVALUE_rI ' - NOII-RESIDENTIAL
.. - - VALUE ^ �_
Land not exceeding one(1)ace Mmedatey >-� ,E -Tr
sunouuNaM residential improvements (1) ;s*'
Other land (2) _ ,. —.:_' _.,
Total and(lino 1 plus line 2) (3) .p
Resldmtlal'lmprove ends or Dwelling (4) FILE. t,t a u y
annually assessed mobile I
manufactured home Garage (5)
Other improvements (6) Uhl. Oho-[0_G�yi tit .
Total improvements(lase 4 through line 6) (7)
Total value(line 3 pea Una 7) (6)
I hereby certify the above b true.correct, 54nalum°tAsst113S6N COUNTY AUDITOR o'mw71°d(ant%dax veal
and complete.
Veayi g edao i-Genoese ctAudm Data steed(matt day,year)
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or$45.000.
otwensfance g any cuerprovisiai the sum of the deductions provided in IC 61.1-12 to a mobile home S
that is nor assessed es real properly Otto a manufactured home thatis not assessed as real property may
not erased one-ha(l/ of the assessed value or Me mobile home or nsyNactaed home.
Date signed Ord%dal,Imad
at5 7Qj.n.(k_ .)m. � c D /a ZD/s-
a61 TON:Picked-Casey An or,,Re-Stamped CrN-TaPaye
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