Homestead_NeibertCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
s�ero Farm stre (RS / �-ail
' ResrnbeE by tlro Deparhmrrt d Loral Govemment Fina�e
INSTRUCTiONS: See �ewiso sdo b�rp fnmurlloro.
OR YEAR
('� S� ►tc�i
`�� SEP 1 9 2
��e��������� �� %� ��/ ���� GIBSON COUNTY AUU�ivn
,c cerUfy that on the ist day o( March, 20
I(We) occupied as our principal place of residence the Following descnbed al pGroperty tor which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under wnlract L� �
, Have a benefidal interest in the entity tha� is liable for the property taxes on ihe property and that owns lhe property or is buying under a wntract.
I( buying on coniraG, Fce Simple ownefs name
Remrders olfice where conirad
County
Parcel number
Tavnship
IRewrd number I Page
";.-"�j'#.� �'<Y. �'F "liv`�F�''rTY.' LL�
: riry, (0 � n, townshlP)
the o ertyiyQUesG9 :
I( any ponim of Ne resiEenilal aWcwre or Ue land not exceeding ona (1) acre Ihat immetliat y surtounds
a��ea������������ a s�a
,4e
�� #' aG- /8-o�-'�ao�/. ��a-o�/
Pr��,C a,y '_-y, _'_ "' . _' __ "�... _ " _. _... _ '
2i �� 'rs�`� � ��i�a'-3;.+-� �=:�PROP.ERTX OYVNED,BY CL'AIMANT IN�OTF
County Tarnship County
I hereby cerlify the above statements are We, coned and compiete. " Si awre la',
(number and streel, dry; sfa(e, ZIP code)
Real {�rop�ty ❑ AAOblle Homo (I.C. 61.1-�
ire is u b pfoduce income, describe the use and portion
'�"� $'� SSESSORIIS N Y �'� � �� TRUETAX�i7Y ASSESSED'VALUE� �.HOlAESTEAD � � � �� ��h
,. �, ,,,,{NON�tESi�ENTIAI
;-�. ....,— e1.� mi^�5 �o;L"4'�°`s�'i�'� 3�� _�� 1'�a� .VALUE�i�y�. �AT�700%OF��TTV,k �-�p,�;YVALUE�'�'.Z�?: ��.�.v�U>�z..VALU�-. �'Cw.�?*�
Land not exceeding 1(one) acre immedialey -- '"� �� ��"'`;�`��1rz�� ����
surtounding residen6al improvemenls. (� � � � �"s "� �.y? <zqv,'� z ar
Other land `� �� � �. �
(Z) ^.�k���,.�r�'+_i�
Tdal land (line 1 plus line 2) (g)
. �, � .�-tr ' - .�_w=^ _
Dwelling (4) �=i'�iy �y`�`�`,r„ ifY$"��WC �
n:'E� �e
�ResidentiellmprovementsorMnuaDy �'"'�""� '°�"`'��''��`��
Asaeased MohBe / ManufacNred Horro Garage (5) :✓.��i x�4',s�'*t��' ,
•.,� . s+�`5,.��'� :�x��Ca���
Other improvements 6 '��'!''���� �s
( 1 :°'�`„�_,,�i'7;z.-'�F'�r
Rial improvements (line 4 through line 6) (�)
Total value (line 3 plus line � (g)
I hereby cer6fy �Ite above is We, torred, and Synamre of Assessor Date signea
complele.
Verifying aUion - SignaWre of Puditor Date sgneA
�l�'�,c�^�-�9.��`2 ..�t,�s�`'Y''"-.�z�'a✓T�s#�''+�;ia3e�'���xs-rt=STANDARU �EDUCTION�ALCOWANCE...� �r.eS"a`. .7��'�9'��zts'ai�r�.�.�i'���`P,����7r>��'.—_°�1..t,
20_Pay20_
Lesser of 12 Homestead S �
vauauan a 535.000
Signalure of Nidriw - Date s'gned