Homestead_Przymus '
4.
•
,. f°"*7: e• CLAIM(FOR HOMESTEAD.P.ROPERTYTAX ,
, 1; STANDARD(S.t1PPLEMENTAL DEDUCTION" FORM •
• r •
t "fix. 5 Stat• e FOlm'6dTJ(Rte r 1-23) . . r HC10
4„P.,. „ p. Presulted,gy the Department of toast DovernmeN RUMS' -
i,4.. , t S .'INSTRUCTION&Soo foveae aide ki Mg lnshvcttons .
C NOTE:Tole hone.Soe]ol Saturn dn4ors tiegnse,Italia idantillasi Pn and faderat W fllt rattan.iumbors are canfdenttai under IC 6-t:i-12-31.
CERTIFICATION STATEMENT
� Matthew. 6 Joanna Przymus •�
'* � � !(ebb) � � certify,itit)(we)ocauptod as my four)Wirxlpol Ptah of,.
resklartcs or am(ere)buying the follov(,I^� scrod re p any tm1ar conbect torwtdch a Homestead Properi1 Tee Standard Deduction Is hereby claimed oo the .
, �dala.Uls epplkel�tbsigned. 1! -`jp '.( (datedatQnahru).i('.`ta) .. - '
Ckvn. t Am far y WAN under recorded convect.. ': ' I ,
•H •, Q Am:(om)called occupy as a tenant-stockholder of a ceoperalNe fang-mrporaOon ;yt.
`° ❑Have a benefrd II Interest in the trust or the ngh to occupy the progeny under the tones eta qualttedpersonai'residencetrust '" -
r a ❑Am(are)the shareholder.penner,or member d the amity that awns the Properly, •� ' ' !
ti i CONTRACT RECORDED
` II awing en Contract Pee Sknpla Ownety Name 1,,l •f + 4 -
Recadeh ORu Vvnera Cwurod,s Rewrded 1 ; t.. �. } 4.. Recar¢Hymbsr ._ 1
t , ;'h. i `a.. , r 1 sr t.. o+ T .,. h vt F .� "- .
PROPERTY DESCRIPTION a _
Comte 3 TownshNP • t; Tasing Olstdct(dry.tmvr tewns(+tP) r at to -tyc. 9
Gibson 3 1", ' ,,,025 .- . i t Fort Branch aY(f . .l] [O
Portal Noma*? ,,r .n Legdi DasaIPtbn v t Yi) )*i t Sa ibe property In 4uetben. ti` '' , { e
- i _ 4�';}a 1. A?se dm tila ic°,0i I T)
,,; ` � y h t tom. t „�.[�iteaS PtaPanY`f � � bi.7-
. tl arty pdNan of Itle.rrsidenllal sbudure or the land nolasraa6mg one(i)ace thaS(mme�aSaty surrounds that structure is used to - eseiba(Muse and potion
oJtM pNPer4'utgWdbP'°C`x°tmDm0. t' ii t S� t} i`'' {• ;uti r :. t 'F yl
r ! a !� .',; s't t 1 ttt34 Ltr r t-,,� 4:r�w t ,,,,._ r
F . F , D aR
2619_184400 00''0,38 025 sti > u ; '.' . ,ti< .._, ,. - - O
PROPERTY OWNED ELSEWHERE-BY CLAIMANT
l ( r i I <• to akriantVicabng' Homesteod? ',� L . ` oa i State-.:County,'•7o•:::-% - .t•. t t , 1 r t r ,Ct a r
` t ,,4,r tyre .tir„ t V}� -fl . Y
... ', a t 'h3 e5 r t t v3.r� •Slgnat tar ; r
ffi e.• r ' Ihereb cesty the above statements ere tru `correct.andcorPiele r er • '
' y s a1 1J,rx k.. f , t t�, t � t .. AJ( r a r ' Address at Vetat !t any(nu and at trail,*able end ZIP coda) 'E
1 Address d Canted(number Indatrast,a7Y Rate and Zip r da) r s t.,yv }r • .. • -
746'SSunnse pr;`Fort<Srarich.tN;476481, Q
t` ..1. ,:5 .,.:"_o4•' .,,,_ t Ao-.. "'LJ Ili,. `—sue
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE 4 NON-RESIDENTIAL VALUE
-' '
suomNat nding Reside One mprove ant -ate (a fi, , •-,
H t t , t
rr x )
'" .'surrounding RasldonUat Improvement
rt,
•
1, e; ,«;1. Orh9r Lend• .40,,,:x ,, x _ - ,
a
ill }lL 1f
i} t i S '�
1,. N t i t. riti F i 1} j ,#t L� S ty t'a � x r 1 1
�;" TotaI Land(OfO,i plUS 1fl0 s)t ' ' C (3}`' } t i ,
I iti r. p':kP 1 t f dt qY4 i r t ' ,
S 4, x
e r t Rasitientlal Improvements o(t ;+ � t)tvelling r f t (a� „h { t
e Mobllet'
r 'hlt)tutec/lad Ham t { - ,
' ) s it
t Nlanufadl•redHom� ( ;Gan e� ''fir .
rl • q 6t i � r ,
/, iO erlmpro'venirntlf . ', �,r v r ()tit ( ,
t n.'; P j Total Improvomgntg r1Une 4 through Line 6)1 ,, 4-.. c7) 4` irr C , } �, f. 4 y
i , k 4
, 1 - ( t c} ,ir"`t t8)f'tt�`. #.v1 7 i• t • - ,
Tvtal,Vatua{(1.jna�Plua,ttne 7j C 5 t j Dote Signad(dab month:year)
i Siglahre a Assaswr+ ,. i
'' the•bove`I,true"correct and complete ' $.' ' ( 1, 4` - ` '
t• l, r°r ( eiaby cartlfY.r „ t r' i k s; • om.sly ed'(dar.memn reef .
f V � SigtuiundAudt'- 1 1 c , ( ! 5 tt y , sFz • ., .- •----3= f
1 ` t •
j '�lr J.i, t t t r at, ,, i y y _ __ ..
STANDARD DEDUCTION ALLOWANCE i
..-1. ;,' t s ass hamcstcad ar$4a Q00 y , .
zt 20.1 Pey 20 }t ri ossa of l of the a s1 e3vatue of tt)a ti. r• r°t
ti
at idng art 4o I ptayst hsm o()esa daduato Frov(diginC6!-!t2toarwbUehom hops Mal $
t
Nh6ntQ sy-p i Ot7 mnufim(urgd hcvna hat{s not as6asse as restproAartYmo Hat F t ,
{iscoata
do-of.01(saa(2�r drhrya 3davofh mdblla hams armanafacWrodhome o
,p((a StOnc:d(month d ay year)
�y Slgnaba.of Am Or t t• trrt ' x ��! Y -:r -.1�': •-tt
n j ru MichaeliA,Watklns;PJB • � ` Z .. .