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Homestead_Goedde (12) .,fir CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 4 '�- STANDARD/SUPPLEMENTAL DEDUCTION FORM Sac Form S4T3(R17I 1-16) HCIO Prescribed by me Depamsa d local Gorenmere Fate e NOINSTRUCTIONS:See reverse Secsitebverrp7ense,Sor¢ NOTE Telephone,SONaI Security,driver's icense,state imlerm65raAfn and feterelT numbers are n5dettaJ wider IC 64.1-12-3 - I I(We) I l JI 4m ,Ca,6-4-r3i.. A O eat d P certify that I(we)occupied as my(our)principal place of residence or am( )buying the following described real property under contract for which a Homestead Property Tax 0 U 2018 Deduction is hereby claimed on the date this application is signed, (data of signature). I(We) itt. ❑ Own. 0 Am(are)buying under recorded contract ❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation- rr �//fi�i'xI-•�� ❑ Have a beneficial interest in the trust a the tight to ocamy the property under the terms of a qualified personal resideno i5t ❑ Alm(are)the shareholder, partner, or member of the entity that owns the property. GIBBON COL NTY AUDITOR Na�me a claimant(legal roma) T cul" I r a as ScOae((.—as elt / a(ed��Sow� Reorders office Where cataract is bred R.mrd reenter Page Canty T°amsh'Pn ' �� " Truig&arid( lain faurNP) GIe vphdi5� ahnsan Twits Ate Pam nsvmaer tape dea�iptam Is are in question Real gamely ❑.4evm!y maned mote,lee(IC 6-1.1-0 II any per on a the 25pa0a tmmae aen lad relessnlc an(1)acre that nune&ately eunaaos eat stmm.a is used to proatee florae deacte to me and porecn a de Frvpay taleed to Pv&m mart 24. -/9.32- yco— oo2 . 92,5- D(2 ' _ PROPERTY OWNED ELSEtYHERE BY CLAIMANT. -. r Sze.Cana.and_y TO*nYtlp , / Is claimant vacating a homestead? N Gibs oY), 0/Critm 5anJ ❑ Yes ❑ No .ssaedtlamss 4/ / I hereby rutty the above statements are true,COfled,and complete. ��JJ I, d ramtaa(number aa soa2 crty, aid ZIP coat) Aml&ana+alatl lmanest:etl.a ,!lk..wsaer./m.rsa and Zamarle) 696 1O25 iloocifizt IN 4763' { ASSESSOR 115E ONLY _ ) ASSESSED VALUE- ',.I. HOLlESTEAD VALUE i �' .NON-RE IINTIAL DE _ surroundt ing esdntiiralle(nl)prwemmmmnb_: CO --s ; - s. xl ; Total land(lire 1 plus line 2) (3) 7.1 Residential bnprovemerts or Dwelling (4) ;s _ 3 -- nmualy assessed mobile/ t!Ffal -.et -.t-:.,t .j mandachi red home Garage (5) _:.?A.s_—,..�.- i. ... >:_ Other Improvements (6) ._fV:.._t -1 ^%_ Total improvements(lime 4 through line 6) (7) Total value (line 3 phs lane 7) (8) I hereby certify the above is true,correct, S rtAtaes.a Ore sired(t:slk dolt year) and complete. Venire eaten-Signature orAudio Data steed(month day.year) .e . . - f'STANDARDDEDUCTIONALLOWANCE; - _ -- . 20 (R pay 20 Lesser of 60%of the assessed vdue of the homestead cc$45,000. Not serstandlng any other provision,the sum of the deductions provided In IC 6-1.1-12 to a mobile home $ • that is not assessed as real property orb a manufactured home Mans not assessed as teal property may not exceed one-hat(12)rettthh`ee assessed value d the mobile home or manufactured home. siTabn d��S.J(YI.C'Y/V Data dgrea maze.2_0 rem 06LRQtUfION: Audhr.Fe.- dCccy-T er Page lot2