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Homestead_Calhoun (2) • e CLAIM FOR HOMESTEAD PROPERTY TAX YEAR 5 ' STANDARD!SUPPLEMENTAL DEDUCTION Fay o Slat Pan 5473(R17/l-16) HC10 ) Prescribed by Me Department of Loral Government fame WSTRUCTrONS:See reverse side for gang instructions. NOTE Telephone,Social Sanity;drifer's'cense,state iden55cab'an and fderalIderCacabn numbers are mn50ential under IC . 1 ' 7. I(We)_ _certify that I(vte)ociaopled as my(our)Principal place of residence am(are)buying the lowering desanbed real property weer contract for which a Homestead Property Tax+Stapd rd application is hereby claimed on the date this appfion is signed, (date of signatuie ): ?Olt )gcm.- ❑ Am(are)buying under recorded contract ❑ Am(am)entitled to oca)py as a tenant-stotldtolder of a cooperative housing corporation. ❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified Person -- ❑ Am(are)the shareholder, partner,or member of the entity that owns the property. GIBSON COUNTY Al DITOR Marne et(Mir paged mai Soda) Soma Searty nutter of drones spouse(last ere dgas) Oeiveri iceva l nvtenatai I Craw rumba d datrna•Ys spade(Iasi Se dyad tasvg State WO:able afyaeppr:ertrs spoor dos nr late e aw>b seamy nareej - _ - CONTRACT RECORDED r - _ - a Nord a;mr]acc me c_i—Q A do c� Recorder's oeoe wlme�0ffi isr% riled Record ones Page IV 201S, Si Si ;- - Carey/.1 bested_ f GIB Sent— Yc het sort , Tway d¢tricr(r>dY.//amm y S, 4+. . Pats neater lIndmagpsan Is inY'tTasYas1fT-1'I.1.Dt- T•^ Red RNsty 0 Annually assessed amble!fuss(IC 6-1.1-7) 6 any pain of Me resde:NI strumse or the land not eseedcg one(1)acre tat immedidely swards eat structure is teed to pro&n inmate,aesmte the tea ens portal d ere popery Mired to product imm. 26 — 23 se,-,Zoo-- ODD, g/I--0C 9 a • - _ - PROPERTY OViNED ELSEWHERE BYCLAIF.MANT t - SON,Casey,and Township Is claimant��/pm'p a homestead? TA l, G, bscn , Qohn c are.. ❑ Yes No No I hereby am amity the above siaemetls are hue,correct and complete- . .`-.•.- .l4C191.47) Adhm drafal(cornier end street etc sib.led ZlP rah) ....__rtsamledteaseasaa,d eel Number are rd.dlY.s3.b.endLPasb) -T1 ASSESSOR USE ONLY I_ I ASSESSED VALUE e.cI Hof ESTE D VALUE_;T R ASIIDENTIAL - :%;a Land riot exceeding one(I)acts Immediatelya4 E. s- � surroundmgresidential improvements (1) An-<•-F#= S" .,.;r- (2) r �x -T Other land -....:;-O"a{_c,?e,-_u::-Y,f Total and(line 1 plus One 2) (3) Residential Improvements or Dwelling (4) k e ' ,c �- _ annually assessed motile 1 manufactured home Garage (5) ',.f.-`.- L_ _.- __,.-. . - _ :.. •H a�' S-_\ Other improvements (6) _ >5 e f-._. . Total hnproveme (line 4 through Una 6) (7) Total value (line 3 pia One 71 (6) I hereby certify the above is true,cormct, Signature of Assessor Date signed(orb,mg yea and complete. Veaybg ado-Sipaase cN non( Date sped(moo*cey lca) 20_pay 20 Lesser of 60%of the assessed vdue of the homestead or$45,000. . NoM'Jrsarc6ng any other provision,the sum of the deductions pmrided in IC 6-1.1-12 to a mobile home S - that is not assessed as real property or to a manufactured home that is not assessed as real property may not exceed one-hat(1/2)of the assessed value of the mobile home or manutractuial home. -Ce 5 Styx l c / 2//o p 5 DISTRIBUTION:Original-Carty Auger,Ft>Slanied Coy-T Page 1 of 2