Homestead_Corn (7) ,.._t CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
4. ,-:k STANDARD/SUPPLEMENTAL DEDUCTION FORM
rr ' $ffitaFam5473(R17/1-16) HOD
Cti�rf"7 Prescribed by me Department or tat Cbve:m art enan e
INSTRUCTIONS:See revene side tor fUng instructions.
NOTE Telephone,Social Secaty,driverY Sceine,state identification and federalldrftaSon numbers are confidential under IC 6-1.1-12-37.
• CERTIFICATION STATEMENT
•
I(We) /�/7/L/�^� -f ceftay ttlatl(we)o i.,_i _.ail .r). I-
pace of residence or am(are)buying the following desrnbed real property under contract for which a Homestead . ..... i2 I,)
Deduction is hereby claimed on the date this application is signed. (date of signature). `e-
YyI Own 0 Am(are)buying under recorded contractMAY 20t9
❑ Am(are) entitled to ootupy as a tenant-stockholder of a cooperative housing corporation
o Have a be,tri d interest in the tout a the right to occupy the property under the terms of a qualified personal resWen
❑ Am(are)the shareholder, partner.or member of the entity that alms the pi,perty.
CLAIMANT'S INFORMATION - - t.. . - . }..• .
-Names re9arare)
Sods Stony amber at dsada space bad 6.e dials) Driver's kern rssontdtlil lower ruares of daaats spouse(lad five dab) Issa*Sxe
Iu)0 a0 Amicable cn0 spare dosses have aserial»Y marten)
� .
U ionic an anaact•Fee Sent canon nano
• Recorders Dace where contract is recorded Redd rooter Page
_ ' �� ✓ _ _ +PROPERTY DESCRIPTIOV - . . 1
County Taal Ta to ' city,tam amtshfp)
Pacer runber Leget 5 A c be.Pryay in meal=
Priawa: d 9 02 - 8 Realp0saay ❑Amway assessed resole rase(106f.1-7)
It err:porton oMe resdenst mums a ee land r a eseaEq one(1)axe the ermetaey surrounds that saumre is used to poorer ivnrme donate the use an potion
a the prepay robed b peacntone.
51 - 9. 9- a, 00 - 000• L 3 / -D64
. -. , PROPERTYOWNEDELSEWHERE BY CIJAIMA NT t- -• - - -
Sete.Carty,at Toms,* Is claimant vacating a homestead?
❑ Yes ❑ No
I hereby Certify the above statements are true,correct.and compete.
a wad(water at same,c%ffie,end ZIPmdh of naiad dart(number an Meet,ay.sude,end ZIP code)
l30/49/ ,27C •
i r ASSESSOR USE ONLY ! ASSESSED VALUE HOMESTEAD VALUE ALIUENTlAL'yp
Land not exceeding one(1)acre Immediately
surroundmg residentbl improvements 1
O zv ��'1 a;.Is
Omer land (2) a ,-r4 r .�� }] —s� J N ' 1
Total land(line 1 plus fine 2) (3)
Residentialwallyssess mobiisa Dwe61m (4)
annually assessed mobile
manofashired borne Carags (5)
'`��,?-vim s 1'r d ,..
Other Improvements (6) _ _ „_ __=.-i.:rs� .
Total improvemems Nine/Nmugh line 6) Cr) GIBSON COUNTY AUDITOR
Total value(line 3 plea line 7) (a)
I hereby certify the above is true,correct, Siyrarm aAssessa Dn daea(nM.h,daY.lea)
end complete.
Veitrig atin-Signature of Anchor Derr egad(oeryA MY.yea)
20 pay 20 Lesser of 60%of the assessed Woe of the homestead a S45.000.
Notw'J,standtrg any other provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S •
that is not assessed as real properly orb a manufactured Rome that is not assessed as real property may
rad exceed one-half(12)of the assessed watts at die mobile home or munttacoaed home.
Sgtffise trw cur 1 Don done](=MO ay,ywan
IxS1RBUTION:Original-County Am/acne-Sumps]Copy-Tamaya
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