Homestead_Might , g CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION µ (/�[]
1iy, SbSheaFmnssl3(R17/1-10) 20\C1'
_V
Preened by the Ogshee rl Leal Go. ,.�.Fria®
INSTRUCTIONS:See reverse side for bang instillations
NOTE Telephone,Soda!Seaafix divers icense,state iden55m5on end federal idenalwym numbers are confdenffal under IC 6-1.1-12-37.
I(VVt) h ILIA*^tat l certify that I(we)occupied as my(our)principal
place of ' a am(are)buying the follordng desalbed real property contract to which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
❑ Own. 0 Am(are)buying under recorded contact
O Am(am)entitled to occupy as a tenant-Stockholder of a cooperative housing corporation.
❑ Have a b is fiud interest in the trust a the right to occupy the property under the terms of a qualified personal residence bust
❑ Am(are) the shareholder, partner,or member of the entity that owns the property.
•
ewro cal L rl h1-
Soml
haws nor ha a social sacrety msa'r)
CO(NTTRAC_T RECORDED
e bur to Meant-act.Fee Shale awns name ? 1�
I l pi
Recorders ogee Wee mrecordedtaf is recorded F IL Read number Page
L s
Conyy1 �,/� TownshipTownshipTatty chid(my,Mem trmNp)
Pap • legal desa» in a queaa
GIBSON COUNTY aaapely ❑AxWy mead made hnoc6-1.1-7)
tare potion of the re dens aware or en land non exceeding one(1)acre that immediately maize is used to produce income,desalts the use end rector
of are properly bred to arcane inane.
3 -- /3 -ZG -2o7- - 00o . 077 -62. 6
.- - - - - PROPERTY,OWNEDELSEWHEREBYCLAIMAr1T _ _ -.
See.Casty.and Township . Is claimant vacating a homestead?
V ❑ Yes ❑ No
I hereby cortfy the above statements are true,cored,and complete.
Address d coact(antenna-• c$:Cde,and ZIP=e) �\Andrea of scaled huaros: J,a aof Number and owe,city.state.and ZIP aide)
Sots 1 -u .. • Jn
'ASSESSOR USE ONLI ASSESSED VALUE I H(5t1ESTE DtALUE ‘4• NON-RESIDENTIAL
Lasud not rrounding rounding residential improvements
one f )acre btaly
Other lend (2) •'e>~z,_za^:�'.--
Total land(line 1 plus line 2) (3)
Residential improvements or Dwelling (4)
annually assessed mobile/ 4
manufactured home Garage (5) •
Other improvement (6)
Total improvements(brie 4 through line 6) (T)
-Total value(line 3 pea line 7) (6) -- -- - -
I hereby certify the above is true,correct, Signature CAssesar Dui steed(rtrsx sax)sari
and complete.
Vadfsg elan-S*Waore of A:d'srr Date signed(nre&der.lee)
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000.
Nohsrhstandrg any other provision,the sum of the deductions provided ante 61.1-12 to a moWe home $
Math not assessed es real property or to a manNazbred home that is not assessed as real properly may
not exceed one-hay(12)of the assessed value of the or manufactured home.
roned roar*MIY,Mean
Date 1 1 1 •
DISTWBUTION:Origami-Carty As tic. -Stamped Copy-Tamysyer
Page 1 of 2