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Homestead_Watson (3) ,{a. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR �,, \;>` STANDARD i SUPPLEMENTAL DEDUCTION ^ 1� `Ass: secs amsar�(Rn,1-1� HC7O Lo Presobet by ye Department of Last Government Essence INSTRUCTIONS:See reverse side tor Eng rosaucbars NOTE Telephone,Social Seat%dtveh dcerne,stale idNudrkan and federal l n n numbers are tonfidenfal under IC 6-1.1-12-37. CERTIFICATION STATEMENT 1 �� 4 ' ' I .• that I we occupied as ow( ) �A�G / + 1 N certify ( ) P� my(our)principal place of residence or am(are)buying the following described real property under contract for which a Homestead Property Tax Standard gIs hereby claimed i the date this application is signed, (date of signature). I(We): Oven, 0 Am(are)buying under recorded contract contra are)entitled to croupy as a tenant-stockholder of a cooperative housing corporation. ❑ Have a beneficial interest in the trust a the right to occupy the property under the terms of a qualified personal residence trust ❑ Am(are)the shareholder, partner,or member of the entity that owns the property. )/f�(� Remeers odco where cot is recorded JJ4zk4v.V'. I•...ranter Paw GIBSON COUNT AUDITOR PROPERTY DESCRIPTION..,,. „,.- forrity O. 1 T I 1 Taxing their Cory,lawn lrrsrvLryn) ts Peal a(`sm6�J/lLc\y/t_T`V ` /` / ( Krone et Onshore Real papery ❑Atsamay messed mead,tame(IC 5.1.1-7) If any portico d tereddaCal structure or Ns land not eeming ore(1)axe that Enneaa y et,nne is used to produce income,desolae tie use end po4on S tee prcpeity tamed to Poem Warne a6 - \t-3n —3cc - 000 .A60_ I- 0y+ • -- - = PROPERTY OWNED ELSEWHERE BY CCAI67ANY.- , Stabs,Casty,and Toenstr® Is clamant vacating a homestead? ` ❑ Yes ❑ No • I hereby certify the above stag are true,arrest and complete. ),�� — � / Address re cam(miter end sheet atz ar,,and ZiPcorf) Addris. mated hamees ed,deny @nthe and-•--,ay,steer ZIP-••. 35 1 Sk-k._ I , 1, c .yi , : ` -NON-RESIDENTIAL ' ^ASSESSOR USE ONLY - : .;I - ASSESS D VALUE,-•;,, -HOLlESTEAD VALUE�- ^'1 Land not exceeding i hurled/stew .a- ' =.z surrounding residential improvements (1) , si :. -4 Other land (2) Y { _ Total land(One 1 plus One 2) (3) 4x - -As-. Residential improvements or Dwelling (4) ':c^ - _Z -.`va^_'-•=' :, annually assessed mobile/ a.rtan..ted home Gnaw (5) .._. � ,.>, '.,Y.- Other hnprovements (6) T L ;'-.).:_:a` - -Total Improvements tide 4 through line 6) (7) Total value(line 3 plea 6m 7) (B) I hereby certify the above is true,correct, SignaturedAssma Dare Wad(lurk Mx mini and complete. Veayilg croon-Sig a=of Auditor Dam signed(math dry,yea) 20 pay 20 Lesser of 6096 of the assessed va)ue of the homestead or S45,000. Notw(tstanSuy any otlerproNson,the sum of the dectxtiOns provided in IC 6-1.1-12 to a mobile home S • that is net assessed as mallroperty ale a manufactured home that is not assessed as real pmpedy may not exceed ore-had(1/2)of the assessed vote of the mobile home or maradacaued Wain of AudS--lei DISTRIBUTION:Odgi a l-Carty Airier,Fic3mrped Copy-Itt aver Page I o1 2 : C�I(�i t,� i-�1�,:.�i =U ; R��=�iY T�X �:�IT Ffi,R 1;�R �.Q� _ ' � . . � � ' . . - � . //�' �K �C:2 r=ILIfr.� .I:i�,r L�'fIC�tc::. 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