HomeMy WebLinkAboutHomestead_Lefler�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� STANDARD/SUPPLEMENTALDEDUCTION
S•. -- srate Form sa79 (I21z � s�oe)
�a t prewi6ed by Ihe Departmenl of Lool Govemment Friance
INSTRUCTIONS: See leverse side far filing instructions.
�
FORM YEAR
HC10
F���
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I(We) certiry ihat I(we) occupied as my (our) prindpal
place of residence or am (are) buying ih ollowing de bed real property for which a Homestead Property Tax Stan,drard DeduUionds hereby daimed
under mnVaA on the date this application is filed, (dafe o/filing): ✓��'1� �S' 11 ��'
❑ I(We) own ❑ Am (are) buying under recorded conVact GIBSON COUNTY AUDITOR
❑ Am (are) entltled to occupy as a tenant-stockholder of a woperetive housing corporation
� Have a beneficial interesi in the Wst or the right to occupy the property under the tertns of a qualified personal residence trust
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Name of dai an� I name)
Sodal $euiriry rwrMei
Name of daimanYS spouse (lepal name)
Sodal Securiry number a( daimanfs spouse (last frve d'g'RS) Drivers license / Itlentifiration / O�her numGer Issuing State
of da'unanPs spouse (last frve digits)
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It buying om m�Vact, Fee Simple owneYS name
Recordefs offxE where mnGact is remrded - RemN number Page
..�. . � . �
�� Township Taring Aistritl (cify, wn mwnship)
P num Ltgal desc�iptlrn Is Ihe pmp in queslion:
�' �— —� � .� 3 eal property ❑ MnuaOy assessed mo6ile home (IC G7.1-7)
�If any por�ion of �he residenlial sWCWre or the IaM not ezceeding w�e (1) aue Nat imme0iatey surtounds iha[ sWCWre is used 10 produrc income, desaiba Ihe use aM portion
of �he P�PenY uv!¢ed to pro0uce inmme.
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Counry Twvnship Caunry Towrvst6p
I hereby certiy the above statements are We, correct and complete. � (�'�'J�41e of imant � '
x� a,nr
dr (numberaMSLeet,dry,state,antlZlPcode)
� t, �ch / 7G4
, . ., . ,
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Land not ezceeding t(one) acre immediatety K`�'�,`l' 13'�` `�iz�'^.+-'�' �Gj"-s� +�' -
sunaundin residentialim rovements. (�� �+'�"+�%�� iJ'µ�s��•y-:`��'u
Otherland (Z) t`� ^=���``$�;?�
Total land (line 1 pfus line Z) (3)
� � 3 �W ax 7�� �F'�� sni:.
Residential improvements or Mnuaity ��ling (4) a.�.i ,�'.� ��„�y;.f�, y,y.;��,w.
l�ssrssed Mobile I Manufactured Home Gars e � '�.i ^�'t's �r j�`� },,,�3�"x �:.
9 (5) ;t'' '��5:..,rrwi��'�.S'r'�y�iL`'•..4'.
OtherimProvemenGa (6) �„a_. N�,=;n„�p..,Z,�-;
7otal impravements (line 4 through line � (7)
Total value (line 3 pl`a line � (8)
I hereby certify ihe above is [rue, cortect, Signature otASSesmr � Data signed (rtronth, tlay, yea�
and complete.
Vaitying artion - Signayre oflwdiw �� �� �'9n� lmO^�, �y.1T'a)
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20 pay 20 lesser of 60% of Ihe assessed value of �he homestead or $45,000 �
AblwVhcfaMing any Wherprovivon, fhe sum of (he dedurliorts provided in IC G7.1-12 to a mob�e home Nat is g
not assessed as real pmperty w ro a rrenulaUUred home (hat is rot assessed as real properry may not exceed
on 72) W Ne assessetl rdNe of Ne mobde Irome wmanufaGUred home.
Daie mon Y.Y�A
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