Homestead_Cousert (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
.,;: STANDARD I SUPPLEMENTAL DEDUCTION FORM 1Q
Sat Fenn 5073(RIT/I-15) HCIO 20 1
Prescribed by Ire Decant e a Local Government Rom
INSTRUCTIONS:See feverse side for filing in tucbons
NOTE:Telephone.Social Security drivers Ilene,state i&en5Na&on and federal iderbEcabon timbers are conbderdial under IC 6-1.1-12-37.
I(We) ' certify that I(we)occupied as my(our)principal
place of residence a am(are)buying the following described real property alder contract for which a Homestead Property Tax Standard
action is hereby claimed co the date this application is signed, (date oI signature). 1(We):
id
Own. ❑ Am(are)buying under recorded contract
tenant-stockholderAm(are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in the trust a 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.
- _ - - CLAIMANT'S INFORMATION . -
Mime ct claimant oesai
Seal
Sodl Seaaay number of claims<s specs(last ere 6$s) Otters taro r Ideai.Slr t l Otis ruts d dSnatsspam(MC eve dads) Seim Sde
(gipimde aryfappre is sperm doss net have a social secs*matey)
- CONTRACTRECORDEDc '
Ifbyte/moan*Fee Simple mots ease r- .. . .
Recorder's afire Wore antral is recorded Read amber Rage
Cant ToeesNp Tamp&said(sly,town,to :tip)
Pace naAa Legal eesaptcn PoDml in 4mmm s
Real Prgxny 0 0.venly assessed oaaLtme(IC 6f.1-n
If errs pore n a e macl a t re ros saucers o land not screechy ameat iro(I)acre mdamly sacrum a used to crone Scum,d4axhe the use and paten
of ere crossly teas a podm Dome
2 -20-C.\-` koo -000, kSt -oo \
- .- -i" PROPERTYOWNEDELSEWHEREeycCAIMANi - _ - : r,,--
Sena.Casty.and Township Is claimant I. 'Ip a homestead?
❑ Yes ,ry7-nTN`o
a claimant
I hereby certify the above statexnet are true,coned.and complete.
6L4,,..... Ks La -
Adamssacarnet(minter mee
t eet Ott Cue,and EPoad) a tailed lvmsmbtla any(narbecni aLaat,ay.sr.and ZO'cr)
VC0s C 'Fiu1-1S03 "3`n— • -6 `1
ASSESSOR USE ONLY `r `_ I ASSESSED VALUE ;:.( HOMESTEAD VALUE, I NON RESIDENTIAL ' -
Land not - -PI VALUE
surrou drug snsr dal neimprovements1)acre iaLdY (1) - ,y ..Y�s x "
_._ -s O.,Z.
Other tared (2) l a_--. u
Total land(line 1 plus line 2) (3) '
fiesiderrtial improvements or OvyeaYy (4) '• ��� for xFil,i`a +r __
annually assessed mobile/
manufactured home Garage (5) ;.§ _£: z
Other improvements (6) _JULR1 712U.9„-_ _ . -
Total improvements(line I through line 6) 3)
Total eslue Cite 3pka Gre Tl (e) ,11 - 1"
I hereby certify the above is nue,correct, 'a"8 alAflam` GIBSON COUNTY AUDITit*cad("a'x^lax ye34
and complete.
VeayS9 action-Signature dAultor Oat Wed(moth,day,yeah .
I r , . STANDARDDEDUCTIONALLOWANCE - -20 pay 20 Lesser of OM of the assessed vane of the homestead a$45.000.
NoMithstandirg any otherprovisies the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
Nat is not assessed as real property or to a manufactured home that is not assessed as teal property may
not erceed one-half(l/2)of the assessed'rake of the mobile home or manufactured home.
Scram o Podia Dan' sigedO y*)-
aSTRJSUiiON:Originsi-Carey nuts..Fee-Sanpea Copy-Tepayer v
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