Homestead_Hull (8) „,..^FT,. .e CLAIM FOR HOMESTEAD PROPERTY TAX - YEAR
t STANDARD/SUPPLEMENTAL DEDUCTION FORM
'�-�'+ State Fan S473(R17/1-is) HOW n ,
l<yPrescribedO Prescribed t theDepartment
i of total Goverment FiFiancei (�O `�1 1
INSTRUCTIONS:See reverse side tor Ring nsfixfmc
NOTE:Telephone,Sodal Seamry,driver's icense,state ider55ca5on and federalitertdca5on numbers are c nfiden cal under IC 6-1.1-12-37.
I(NL') Pre tk • a certify that l(we)occupied as my(our)pampa)
place of residence or am(are)buying the folloving described real property under contract for wtnth a Homestead Property Tax Standard
Deduction is hereby claimed on the date this application is signed, (date of signature). I(We):
(are) enti to as❑a Am enant(are)txrying tinder of a recedperative ed ve haa-
.i housing tled oowpy t -stoticlwlder coo cwpaatonC .
❑ 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 plopelly.
- . -
ebryipeecoenactFee Scapa owlets name t I 7
Recorder%once where meted b recorded AUG 6 - 2019 Ramie number Pepe
prwn_„- .
Carey T� ����Ii'—'rum mw+� '
GIBBON COUN V nU 'fT(Ytipp
Pam aster Lags cascy:on Ndtl'pltdrn n Auufac
❑Rea prapcly 0 Amway messed Cate lune(IC 61.i-7)
a err pram of the noldential sauase a'ea lad rot exceeing one(I)sae Vat'vn' dy samtbds tut manure is used at produce bonne,desobe the use and polon
al the prtpaty mitred b practice income.
.2,-6 _l2—iR 7 (90 —Goy .T 12-0 2-3-
.
'� PROPERTYOWNEDELSEWHEREBYCLAI(.ZANY -'
Sat.Catty.ad TwrS Is claimant vacating a homestead?
❑ Yes 0
,y( orcteSt
I hereby certify the above statements are flue,correct and complete.
Address doomed(M1athrand:beet silt Yob,and Ze al*l '\ A•is hotk� a tl tin.sue.ad p a 1 lel
`=ASSESSOR USE ONLY .- : I ASSESSED VALUE',-F HOMESTEAD VALUE - ,•4 NONRESIDENTIAL `v. �^
VALUE �I{10
Land not exceeding one(1)acre hnmediataly ti z F-r -.(
surrounding residential bnplovemenb (1) :k 'O.. _ ` r--Si ti .
r -
Omer land (2) fer,ie_ ' ,_.c:t.
Total land(line I plus line 2) (3)
T?r
Residential improvements or Dwelling (4) _
annually assessed moth/./ _
manufactured home GarageT-1 is
Other improvements (6) r r<r:.'-e' s •*- _1
Total improvements(line 4 through line 6) (7)
Total value (line3 phis One 7) (9)
I hereby certify the above is true,correct, Signature°eP"--' Date signed(maxA clew yea)
and complete.
VatYng rem-Sense oAudbr Date Wed(matt�:year)
p • ,__ , , - t 'STANDARD DEDUCTIOrd ALLOWANCE -r - .. -
20 pay 20 Lesser a160%of the assessed value of the homestead or$45.000.
jmiprovision,the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not, •a,real property or to a manufactured home that is not assessed as real properly may
not ex 0 /pot the sled vale of the or manufactured home.
” C-._ . Date 7ttdattel,
DisnastliiON:otiose-Careystsret - --..
Papa 1 of 2