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"' CLAIM FOR HOMESTEAD PROPERTY TAX
ir _. . STANDARD / SUPPLEMENTAL DEDUCTION
State Fo�m Sd73 (R72 / 609)
S � PrestnbeE Cy Ihe Departmerit of Lool Govemment Frence
INSTRUCTIONS: See ravarse side for filing insWctbns.
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MAi`Pc�l 20
C.�.�
GIBSON COUNTY A
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1(We) ceAify Nat I(we) occupied as my (our) prindpal
place of residence or m(are) buying Ihe folbvring d real prope o which a estead Property Tax Standard Deduclion is hereby daimed
under conVad on th ate Ihis applinGOn is filed, (dafe o(filing):
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled ro occupy as a tenanFStockholder ot a cooperative housing corporatlon
� Have a beneficial interest in the Wst or the right to occupy ihe property under Ne terrns of a qualified personal residence Wst
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Name of da'unani (kgal name) \
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Sodal Seaaity nmtel
Name ot dafmam's spouse (lepa/ nertreJ �
Sodal Secvriry numha of tlaimanYs spouse (lacf frve tligds) Drivels GceM1Se / Identifimtion I ONer number Issuug State
� of daimarrt's spouse (Iss! five d9�)
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If buying m contrad,� Simple fs e �
Recordefs oBice treG is re�nrdeE - Reoord number Page
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..,. . , . ,
�nry Trnmship Ta�mq7 d'abia (ri(y, fo iP)
Parcel numher Legal desai0� Is Ne propury m question:
' eal pmperty � MnuaAy assessed mobile Iwne (IC 61.1-7)
if any portbn d Ne resldential strucEne or IAe WM w1 exceed"ug me (1) aoe Nat imrt�ed'atety wrtaunds Ihat smx9�re is used W produce income, desaibe Ihe use aM portbn
a ma wovem wra� m wm� �,�.
ae-�9-i 9- io 1 00� �?l 5-oa �
-.. . . : . .
Courrty Township Counry TwrtaNp
I hereby certity the ahove stetements are We, correct and wmplete. S' re da" � �
i
ess (num6era reet, tiry, 7e, andLPCOde �
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Land not exceeding 1(one) acre Immediatety "`4 ��F � �`��t�
surtoundin residentialim rovements. (7) �u ���.:���� � �
�'i's a. �,�tn"-C:za�.a,
[, fj��..�'t."��?y .
Other lantl (2) ��s�:,� �*i'^Za�
7otal land (line 1 plus line � � (3)
Dwellin �,�'�� xj���� ,�
Residential improvemenb or Mnualty 9 (4) �-3x b sf� sc `� �-
Assessed Mobik / Manufactured Hortre �"�.°+i�'� s�' ,� 3.�m F5 �FY":
,�+_
Garsge (5) ��� "4j �i?�e��.P'i..':���
}s= '.�?}T�":'='£
01her improvements ' (6) • ��,�'�.:!;r�.�+�'�� �
7atal Improvements (Ilne I fhroug� Iine 6) (7) '
Total value (l(m 3 plu!!na � (8)
1 hereby certiy ihe above is We, cortect, Sigr�awre of Assessar Date signe0 (monN, tlay, year)
and complete. .
Vailyi�9 actim - SigfaLire oflud�iw � Date signeE (mon7A, daY. Y��
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20 pay 20 _ Lesser o( 60% ot the assessed value of Ihe homestead or $45,000
NofwiN9antlug anY ofAerpio�ision, Ne aum oI Ne deducfiorrs providetl in IC 61./-1210 a mo6Pe home lhaf a $
not essessed es real proparty w to a rrenulartured bome Net's not assessed as 2a1 propeM meY not esraed
ono-haH (/2J d the assessad refue dNe mobie home wmenuFac/uretl hortie. �
SignaWre of Audliw Date signed (rtqnfh, day, Yea�