Homestead_Williams (6) ,cr. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
• E'!�<a;. . STANDARD/SUPPLEMENTAL DEDUCTION FORM
r{- " 1 StateFam5en(in/1-16) HCIO ..
fuel V Resorbed by the Department of Lod Goverment Fiaca if
INSTRUCTIONS:See reverse side tor CEng imbtobers
NOTE Telephone,Social Security,divert kense,gate iden53ca'ion and federal itl'1E& m .=ca6 ramie are canfdenbal under IC 61.1-12-37. / /
^� CERTIFICATION STATEMENT .
• I(We) 1)0 ni Qd 8 ) L I \ Q yft S certify that l(we)occupied as cry(our �y
place of residence or am(are)buying the following described real property under contract for whidi a Homestead Property Tax ry
Deduction is hereby claimed on the date this application is signed. H a—ten (dateofe nature, ):
CTyvwr. 0 Am(are)buying under recorded contract. —leSOA 1�f9
❑ Am(are) entitled to oa:upy as a tenant-stockholder of a cooperative housing corporation. CO .
0 Have a beneficial interest in the Must cc the right to occupy the property under the terms of a qualified personal resid - -
❑ owns Am(are)the shareholder, partner.or member of the entity that the property. ,9
immalimmmummic=amninsimmiiiip
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SomlStenty manner dr sperm(bs be dges) Diver's in r ianimtac r Otor nester rl claimants gave(last eve duds) Issued Sate
(gtpimUb ate te{pacau s spocse Sias in law a axial seam*rider)
•
IIburs]as antral.Fee Simple eta a's tare
Remda,odes where sired is recorded Rand rained Page
•- - , - •- _ 'PROPERTY DESCRIPTION - _ -- _Township Taxing Tmne dated(an;brut tranship)
1 bZSar 1 t---1 tOn . . ,
Perim mrba ttegat desapEcn • Is the property in question -
0 Real prgMy 0 Arno*assessed motto tome(IC 6-1.1-I)
II erry ono of the residential trusts or as rand na=mettle roe(1)acre tint mnedaely saraaos that ware is toed to produce insure,desa®e as use ad paten
of as property tared b police Axone.
aki) - aO -O \ - coo - .00I : Is7- co l
- - - , . PROPERTY OWNED ELSEWHERE BY CLAIMANT Lr; .. ,
el]
Rate,Carty.a Tosssds Is claimant vacating a tesleC7
rr aaef ' ❑ Y/e!, '
I hereby certify ^py the above statements are true,correct,a complete. � l lie/
Address of contact Counter and street dry,stde -ZIP date) Address at roosted • _. •,.any(rema b end sew(city,taro,and ZIP coda)
f .S. (DO ./ A/ .„ I r ' •
'ASSESSOR USE ONLY ASSESSED VALUE i HOMESTE D VALUE:L. ,.-�
VALUE NTIAL Land not exceeding one(1)acre Immediately c (1) fi.ZA.r--�
surrounding residential improvement
Other lath (2) �` 1 ,{:_ ....}.-r. .':
Total land(line I plus tine a (3)
�''LED
a Residential e�me�eo Dwelling (4)
APR 2 2 2139
annually assessed mobile I
manufactured have Osage (S) »-.,._s - ,:f>. . ,.-. --
33 V):i
Other improvements (6) = '"`R4�,.__ ..-__. :k
Total improvements(line 4 through fine 6) (7) IFS..
,i-die- Tr
Total value (line 3 puts File 7) (B) GIBSON COUNT DITOR
I hereby certify the above is true,correct Signature oiMsessa oak signed Myatt dd%,ea.)
and complete.
Ventre*action-Signature d Audbr Date sided(=a day,War)
,• _ /STANDARD DEDUCTION ALLOWANCE �, 2 _
20 pay 20 Lesser of 60%of the assessed vdee of the homestead or S45,000.
NaMeirslandi g any other pmsiam,the sum of the deductions provided in IC 61.1-1210 a mobile hone S •
Nark not assessed as real property orb a nendactured home that is not assessed as real property may
not exceed one-hal(1R)d the a.o vibe of the mobile home or mandact red herb.
°Aatle Date dared(malt day:red
DISTRIBUTION:Original-Canty Avdia.FaeSamp*d Ccpy-Ta yaya
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