Homestead_Fugate marry; CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
t�,... e. STANDARD/SUPPLEMENTAL DEDUCTION FORM a 0 k^
Site Partss4l3 0117/1-16) HC10 �Il Presabe0 by the Depama Gb+a at Lag inert France •
INSTRUCTIONS:See reverse side for filing i sbutti'ons
NOTE Telephone,Social Seaaitx driver's icense,state identification and federalideit&ra6m numbers are mntdenEal under IC 6-1.1-12-37.
• I(We) - - J • • certify that I(we)occupied as my(our)principal
place of residence or (are)buying the d'described real property under contract for which a Homestead Property Tax Standard
Deduction is hetdry lied on the date this application is signed, (date of signature). I(We):
XOwn ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to oaupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a b,.a fail interest in the trust or the right to occupy the plvµxty under the terns of a qualified personal residence that
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
CLAIMANT'S INFORMATION
Name Ueda raa) _
Social
SoddSearty camber adatenars space(last the 693s) River's tesel ldntSoben/Other atamber a dements Nava(fast be twig 53e
(Aipaceae does not/ene a axial semltyaamvJ
ff N oir°ono:ma*Fee Sande oaws rare
Returners eece*tare=that is rested FEB 1 1 2019 Ord ma"" Page
GIBSON C UNTYAI)
0 Real popsy 0 Mlvaly assessed mode hone(IC 61.1-I)
If any ports of be resdxos stnumse or the tab not em<edy one(1)acre as innately=mans Nat snare a used b produce inure.desate be to and paean
a the puberty ttSoed b produce drone
aa_ — \ - o l --Ac3 - oc �_ el oroZg -
PROPERTY OWNED ELSEWHERE BY CLAIMANT Sete,Casty,aia Township Is claimant vacating a hanestead?
0 Yes ❑ No
a claimant
/r
I hereby certify the above statements are tare,coned and complete. X '(/
Address aasGci(mnnberWSNesQ rily.=from,end ZIP mb) / AdSessa• ----P am atl ahec.ay,sib.we ZIPcode)
0C. � Arco✓ sfi •
ASSESSOR USE ONLY f . __,-I ASSESSED VALUE -1_, .HOMESTEAD VALUE.j,..Land not � .NON LIDENTIAL -
surrounding exceeding one
in)acre provemeerm immediately
(1) . • `� _
Other land Di :1e`.teloi ?i=i.:e- ^_:°,!ir
Total land(heal plus fine 2) (3) - -
A ▪ - '
Residential step...merits or Dwelling (4)
annually assessed mobile/manufactured home Garage (Si
Other improvements (6) fa?a,.?.r1'r v} ;-
Total improvements(fix 4 through fare 6) (7)
Toll value(fix 3 phs One 7) (B)
I hereby certify the above is true,carved, Signature dilutor Dery sigled(area dex we)
t. and complete.
Votary aeon-cser.e of.ku'br Date signed(moan,red:yes)
r - STANDARD DEDUCTION ALLOWANCE `, . _. - .-
20 pay 20_ Lesser of 60%of the assessed value of the homestead or$45.000. -
IllotudriStanding any otherpmvman,the seas of the deductions provided in IC 6-1.1-12 to a mobile/rote S that is not assessed as real property or to a rnanufacbrred home that is not. as mat puope*may
rot exceed pxhalI(Mot the assessed value of the r1mbee home or
scrlsraaAdded Svi Div V 1 Sw,l � �,4 Z (mattI V1
DISTRG filON:OriginPI-CaalyAult";raaSanced Cagy-Taxpayer
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