Homestead_Lambert 4 r„ '4
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{ CLAIM FOR HOMESTEAD PROPERTY TAX
i 0.0.•yy STANDARD I SUPPLEMENTAL DEDUCTION FORM YEAR
i '�`a li SlelaForm5170(Ala11.20) How 2021
IPrescribed by the Depertmenl el Local Government Finance
INSTRUCTIONS:See reverse side for filing Instructions
NOTE Telephone,Social Securely,driver's license,slate identification and federal identification numbers am confidential under IC 6.1.1-12-37,
I - ,- CERTIFICATION STATEMENT •
I(We) Gabriel B Lambert certify that I'(we)occupied as my(our)principal
' place of residence or am(are)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; 1-2-5-'70 Li .(date or signature). I(We):
® Own. ❑ Am(are)buying under recorded contract
f ❑ 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.
I ❑ Am(ere)the shareholder,partner,or member of the entity that owns the property.
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(Applicable only if applicant s spouse does not have a'socloI sec Iy!WOW'I
-.. ., ,,,,-«°, :,' .. ,' „a, :1 CONfeA6111.1l:�GOtW(L:P,• . ^a ': a,- - :: ;. i °=Y r T-"r'.«^`t
It buying on eontrad FoeeSvnple aw:mr's name
Retetier•cd :o.wham eonlraO Is recorded Rdranr number Page
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PROPERTY(DESCRIitTION - `',`t GE' ,7 ...,
•Caun1Y Tasmahip 'Twang ddlrid N'tfy,town:foyvpint?) I
Gibson Washington Gibson,Washington;
'Parcel number Legal'description Is the property in question iJ av,,(J�/
26-06-16-100-000,169-017 NW NW 16 1 9 19.19 AC C-1 m Reel property ❑Annually assessed mo5151-r5zWIF,'Ft jl )
n any ponioa of the teaidened structure or the land not axes rine(I)acre teat Immedluy surrounds that Mantra Is used to produce income,damps the uo and often U^ITOR
dale property utilized Is produce income ' Fr
~ " , I.. ';'-'-i"-*;; 'b*'�'t rPROWATY OWNED El,SEy'IHERE°BY CLAIOANT n° „ 44: ., "•4
Stile.County,end Tovmahip Is claimant vacating a homestead?
Indiana,Gibson,Washington iz Yes ❑ No
Signature of claimant
I hereby certify the above statements are true,correct,and complete. —
Address of contact(number and sired.cdy.,itch,mid ZIP code) Address er vacated homestead,If any(number and street,ciy,state,end ZIP coda)
5319 N 775 E,Patoka,IN 47666 740 E State St„Princeton,IN 47670 _
die•seBSOR;t1SC ONLY ASSESSED VALUE T HOMESTEAD VALUE. 1 NON•RESIDEN VIAL -
su eundintlrrosldondul mnrovo otltsdlntoly (1) ^•• _ ^-vALue `,-
Other land (2) - • - -
Total land(line 1 plus line 2) (3)
Residential Improvemonts or Dwelling (4) -
annually assessed mobile I -' ,
manufactured home Garage (5)
J -Other Improvements ,(6)
Total Improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above Is true,correct, Signature of Assessor Dale signed(month,day,year)
and complete,
Verifying action-Signature of Auditor 'Dale signed(month,day,yeast
,. ".4-1,:.
e,,,1.. .,..
, ' •._.-. tKwr, . .� ^ y.,. e.� ° ' yr s.x.,a.,..r
__ a., - .- ., - , STANDARD DCDUC TION ALLOWANCE. �(" - ,,,-•s`. " - ''r`fe
20 pay 20 Lasser of 60%of the assessed value of the homestead or 545,000.
Notwllhslanding any other provision,the sum of the deductions provided in IC 6-1..1-12 to a mobile home S
that Is not assessed as mat property or la a manufactured home that is not assessed as real property may
not exceed one-half(1/2)of the assessed value of the mobile home or manufactured home
Signature al Auditor Dale tanned(month,day,yowl
ildikaiS_ 1•______UpaaaLlit; l'- 0/licit-), 1—c9 ri—13)--C4a 1
DISTRIeU-ION:Original-County Auditor,Ftle"Stampod Copy-Teapeyer
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