Homestead_Goldbach rx' 4 CLAIM FOR HOMESTEAD PROPERTY TAX �o ._. YEAR wI
STANDARD I SUPPLEMENTAL DEDUCTION ftcla 2.m •`'
�`- s,to ro,,t 1;n7a(nol't3th C12,
1-,,,,,,a,.by Ma tY' rtment nit cad GermanePt Foss, .-,...._ �_..r _.,.........,.
•NSTRUCT)O+`.S;Soo:rouse side last ang Instructions.
NOTE T,..,optIono.So at Security,flavor y hcensa,state dent,fcauon anti federal klontitirsth n numbers are confdontiat undo(IC C-1,1.12-32.
I(tee) Kenneth C./Robin A.Goldbach certify that I(we)occupied as my(our)principal
place of residenca or am(are)buying tho following described real property under contract for which a Homestead Property Tax Standard
Deduction is hereby claimed on the dale this application is signed,.,. 4/4/2022 (date of signature), I(We):
.
t.- Own. 0 Ant(are)buying under recorded contract. '
o Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation,
o Have a beneficial interest in the trust or Iho right to occupy the property under the terms of a qualified personal residence trust.
0 Am(are)the shareholder,partner,or member of the entity that owns the property.
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d ouSTss oh ceairaci fee Simple WANKS 11.1nw s!Ai r-s 4 UN _'
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Re..sca.r Isoieve whore contract Is recorded Record number Page .0/7. r
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.0 .-,�.-,.3,: ."Flui d. :i..,.... .,t _r',.',.,...'PROP,ERT,1^DESCRerIQN.-. .t. w _. ._. .,., .:*..--:-/. - r ,I.
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County Toanshrin Taxed drstrar(city,roan.torvnshap)
Gibson Patoka Patoka
ti Parcel number Legal description Is the property fit gueseon'
26-04-25-300-000.653-020 El Rom prnpony 0 Annuatrt aaseued meow Iran rs 0c o-r r-r)
It any portion of the raulanLat error one or the tend not erceeMno one(it acre that trtmed atcty surrounds that strucNro to used to produce aroma.desereha me use and punier • -
of the property utTrzed to produce incorrw.
r ..,,we,:.aw_.«.:,:...:`.�.a..m1.ter.,."'a'P,ROP,iRT.Y'OWNED,ELStINNE(2E.fiX CIAIMFiN7,;,..,-r. :3 * ,
SO)a.county.and Tasnan+p Is claimant vacating a homestead?
Q Yes 56Re
4 I,Sionatiue-'� t
I hereby certify the above statements are true,correct,and complete. _-
Address or contact(numaarandsaeet,Gay.stale,and ZIP code) Andres"of vacated Iron estead,d any(rwrrraerand;trcet any.show end ZiPcoda)
(pOt f Cardinal Drive,Patoka,IN 47666 a
s t k ltartatEslDE AL
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IASSESSO US5'ONtN.. .,�° tit'''.,ASSESSED VALUE s l� .1.tOMES`I'EAD VAL1.7C'« t,.,s, S1T1 •( T.
y -N.,A...,:...w•.:x.._o..-, s,ts..........4,..,x=t.:....„s.=�d°es::_..,,..,.rdc, _v...._ ,. ,..e_.. ..•......-,.. k.- r....a. VALUEr:':' :,� .
it
.Land not exceeding one(1)acre immediately (1) _-
surrounding residential Improvements .
Other land (2) '
Total land(lino I plus line 2) (3)
Residential Improvements or Dwelling (4)
annually assessed mobile/
manufactured home Garage (5)
Other improvements (6) p °
Total improvements(lino 4 through lino 6) (7) rt
tad
Total value(tine 3 plus line 7) (8)
t herehy certify the above Is true,correct, $�n]lWe of Assessor Data signed(.ante,day.)ear)
and complete.
Date salned(cent,dal.ye3')
•
Vcrdy+rg arson-?ironware otfrn:wx t,
. "sYANciARDDODucioN%b:OWANtE,',`':,;..,,,mt .,�._,..'x,._.ns�.w.::-
._.., a.,...-..._._..•...,s '.„+ ,eti «.+ ...fit m . vt
20 'pay 20 Lessen of 60%of the assessed value of the homestead or S45,000. ,
llotratrtsland ng any othorprovisrorr,tiro sum of duo deductions pmroderl in IC 6.1.1.12 re a moblo home S
Ural is not ossossed as mat property or to a manufactured homo Thal Is not assessed as coal property may
net excood ono-hart(1t2jot lire assessed vafuo el the rnobilo home er manufactured home.
Date sk}ruvd(moron daj,)ear)
tikdma;u*a dtwaw
iii
_ Cl� o �. hv. 4- _ ()A •
DtSTRtnUT :origami-County Auditor.i4,.Stanyed Copy-Taxpayer
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