HomeMy WebLinkAboutHomestead_Moore CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a _. 1 STANDARD/SUPPLEMENTAL DEDUCTION FORM
HC1O -
State Foram SSA(Rt]I 1-16)
' Presorted by the Department of Local Government Finance - -
INSTRUCTIONS:See reverse side for 55tg instructions.
NOTE:Telephone,Social Secuny,dower's license.store ident.6cabon and federal idenbtcaton numbers are confidential under IC 6-1.1-12-37.
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�. - I_• r ,+._ _. CERTIFICATON STATEMENT -,'. ...,._._.��.. :rw'+ .0 ,,,
I(We) Robert L. Moore certify that I(we)occupied as my(our)principal
place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, 6/14/19 (date of signature). I(We):
O Own. ❑ Am(are)buying under recorded contract.
❑ Am(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are) the shareholder, partner, or member of the entity that owns the property.
Name of clamant(legal name)
Social
in
Name of claimant's spouse(legalname)
Social Seamy number of claimant's spouse Bast five dyes) Diners licenser'Idenphcaten l Other number of claimant's spouse(tan the dgss) lssueg State
(Applcabb only d appacaf's spouse does not have a social seamy number)
... a CONTRACT RECORDED. .11
bag bg on contract.Fee Strrak owner's name
Recorders office where contract is recorded Record number Page i
-. -. ) - `a PROPERTY DESCRIPTION d-.v • '4.' i_
Co
unty ty Township Taxingdistrict(city town,township) 6) • t its
I
Gibson Owensville
Parcel number Legal description Is me property In gueseon: 11�(1
26-17-12-201-000.361-022 IZ Realpropemy ❑ Amway n�le�OA6]L1-n
If any porion of the residential structure or the land not exceeding one(I)acre that immediately surrounds that structure is used to produceincome,desmbe the use and portion
of the property 1432e0 to produce income.
GIBSON `OUNTY AUDI`OR
' .. .1. . _� .:PROPERTY OWNED ELSEWHERE BY CLAIMANT o _- - -
State,County,and Township Is claimant vacating a homestead?
❑ Yes 0 No
f claimant
I hereby certify the above statements are true,correct,and complete. `/�A��,u -/� �I
Address of contact(number and sleet.bay,rate end ZIP code) Address� vacated homestead.it any(nunbet and street,ay,nee and 21 ) I[[Lal a/
/•l•L�
'iR 00 So a . • •.•1 I- r ,, YwI 4 l7
ASSESSOR USE-ONLY II5 ASSESSED VALUE I -^HOMESTEAD VALUE. (I NON RESISIUENTIAL
Land not exceeding one(I)acre immediately . -(fl - -
surrounding residential improvement - ' -
Other land (2) r
Total land(line I plus line 2) (3)
Residential improvements or Dwelling (4) ,
annually assessed mobile — --
manufactured home Garage (5) - — `
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line d plus line 7) (S)
I hereby certify the above is true,correct Signature of Assessor Date.greed(month.bay.yea)
and complete. 1
Vmytrg anion-Signature of Auction Date signed(mantis day,year)
I
20 pay 20 Lesser of 60%of the assessed vdue of the homestead or 345,000.
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thatwithstandirg any otter provision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home S
that is not assessed as real property or toa manufactured ed home that is not assessed as real pmpery may
not exceed one-half(1!1)of the assessedd of value of the mobile home or m nufactured home.
Sigma I Puduu l _ D e syn (mwrc2 day.yet)
DISTRIBUTION:Orgmal-county A„amc Fa.-Stamped copy-Taxpayer
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