Homestead_Weist CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
a % STANDARD I SUPPLEMENTAL DEDUCTION FORM
ItState Form 5.73(R17/I-16) HCIO 2019
J Prescribed by the Department of Local Government Fiance
INSTRUCTIONS:See reverse side forhtirg instructions.
NOTE:Telephone,Social Secunty,dnvers license,state identification and federal idenbfcation numbers are confidential under IC 6-1.1-12-37.
_ •� CERTIFICATION STATEMENT _ - -
I(we) ennwe west certify that I(we)•• w• tar) d
place of residence or am(are)buying the following described real property under contract for which a Honest tiThr a Tax S rd ✓�
Deduction is hereby claimed on the date this application is signed, aAa6rmlg (date o' ig .t ).
M Own. ❑ Am(are)buying under recorded contract.
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation. a,le3 R2019
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified person Bence st.
❑ Am(are) the shareholder, partner, or member of the entity that owns the property.
, .. -
Il buying on contact,Fee Simpleecoemers name
Recorders office vitere contract is recorded Record number Page
. 1 PROPERTY DESCRIPTOR . .
ToonslOp T +-
Gibson Patoka Iu�`&e�t(�Mla =yp)
Princeton
Parcel number Legal description Is the pmpelty n duespon:
26-12-17-10l- .J92d28 O Real property ❑ Annually assessed nebee home(IC 6-1.1.7)
If any porton of the resWbal structure or the land not exceeding one(I)acre that immediately surrounds that structure is used to produce income.describe the use and portion
of the popery utired to produce income.
_ *PROPERTY OWNED ELSEWHERE BY CLAIMANT _ fc.,'• `.
State.County,and Tawnshq Is claimant vacating a homestead?
❑ Yes Q No
Signature of claimant
I hereby certify the above statements are true,correct,and complete.
Address of contact(number end street.coy state,and ZIPcode) Address of vacated homestead,(1 any(number and Meet caif state,and ZIP code)
907 S. Adams, Princeton, IN 47670
-.* '• ASSESSED VALUE I- HOMESTEAD VALUE I. VALUE
ASSESSOR USE ONLY, NON-RESIDENTAL
Land not exceeding one('I)acre immediately I1)
surrounding residential improvements
Other land (2)
Total land(line I plus line 2) (3)
Residential improvements or pneNng (4) •
annually assessed mobile I
manufactured home Garage (5) •
Other improvements (6)
Total improvements(line 4 through fine 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct. Signature of Assessor Date signed(mourn,day year)
and complete.
deifying noon-Signature of Auditor Date signed(month,day year)
.9,214: Onitka 09/06/19
-
-. • - STANDARD DEDUCTIONALLOWANCE
20 pay 20 Lesser of 60%of the assessed value of the homestead or 545,000.
Notwias:endirg any other provision.the sum of the deductions provided in IC 6-1.1-12 to a mobile home 5
that is not assessed as real property or to a manufactured home that is not assessed as real property may
not exceed one-half(12)of the assessed value of the mobile home or manufactured home.
Si nature of Auditor Date signed(march,day.hear)
/o' 09/06/19
DISTRIBUTION: Ongmal-County Auditor,File-Stamped Copy-Taxpayer
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