Homestead_Schmits (14) { f CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
-.r STANDARD/SUPPLEMENTAL DEDUCTION 2D��4 t rm L-4 r StateFo5473(R17I1-16) KCI�
Prescribed by the Departmental Local Government Finance
INSTRUCTIONS:See reverse side forfiing insbvcffons.
NOTE Telephone,Social Security,driver's license,state identification and federal identification numbers are confidential underlC 6-1.1-12-37.
CERTIFICATION STATEMENT
I(We) I ' a 1,%1t ).P1 n rlI _ certify that I(we)occupied as my(our)principal
place of residence or am(te)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, (date of signature). I(We):
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.
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township Taxing district(city,town,township)
Id\ '
Parcel number Legal description Is the property in question:
❑Real property 0 Annually assessed mobile home(IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrotmds that structure is used to produce Income,describe the use and portion
of the property uti' to produce income.
Izo
bOL . O-
PROPERTY ,\-
li OWNED ELSEWHERE BY CLAIMANT
State,County,and Township Is claimant vacating a homestead?
0 Yes ❑No
rgnature:�claimant
I hereby certify the above statements are true,correct,and complete. -4s.iNt,..4......54‘t,..... ,
, 7
Address of contact(numberend street;city,state,and ZIP code) IF Add vacated homestead,if any(numberand sheet,- and ZIP code)Aii --,
31 l s�-S-..S ; id , 3n-L-i+-6 42
ASSESSOR USE ONLY I ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL
VALUE
Land not exceeding one(1)acre Immediately (1)
surrounding residential improvements
Other land (2)
Total land(line 1 plus line 2) (3) I 1E.I/1I1i1:').1
Residential improvements or Dwelling (4) :�r
annually assessed mobile/ U L C V ® 20i9
manufactured home age (�
y , - .:
jg
Other improvements (6) :i>."` ;'; -
Total improvements(line 4 through line 6) (7)
Total value Vine 3 plus line 7) (6) GIBS)N COUNTY AUDIT�I�
I hereby certify the above is true,correct, Signature of Assessor Date signed(month,day,year)
and complete.
Verifying action-Signature of Audtor Data signed(month,day,year)
STANDARD DEDUCTION ALLOWANCE
20 pay 20 Lesser of 60°A;of the assessed value of the homestead or$45,000,
Notwithstanding any•.er,,Won,the sum of the deductions provided in IC 6-1.1-12 to a mobile home $
that is not assesse• --re 7ropedy or to a manufactured h••r e that is not assessed as real property may
not exceed one-ha /2). the assessed value of the• ••Ile ho or manufactured home.
Signature of Auditor ♦♦♦♦ Datesigned((tort d ar}_
DISTRIBUTION:Original-CauntyAuddor,File-Stamped Copy-Taxpayer
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