Homestead_HillCLAIM FOR HOMESTEAD PROPERTY TAX
:�._`.� ; STANDARD / SUPPLEMENTAL DEDUCTION FORM
s;r.e Fwm sa)3 (ft15 / st<� HC70
��' • Pm�ibe0 Dy L�a Depanmem of Laral Gwerrvrent Fvurce
LV$TRUCTION$: SCE lBV25B 9CB IO/ II�YNJ IOS'JIICIpOS.
NOTE: Telephone, Sacial Sewnry, tlnvers license, sfate itlenfi:¢auon and7etle21 idenG('ical'an numbers are mnfrCenfial mMer IC Fi. f-
� M'e) 612//� /" l /?I // certify Ihat I(we) ocu�ed a�ny ur p'° �,
place of residence or am (are) buying the following descnbed real property under conVacl for which a Homestead Property Tax Sandard
Deduction is hereby daimed on the date this application is signed, (date of sgn I(AVJe): q� 1C
❑ Um. ❑ Am (are) buying under recorded conVact. ��� Y LO IJ
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperaWe housing corporatlort I
❑ Have a benefidal interest in the Wst or the right to ocwpy the property under ihe tertns of a qualified perso esiden
❑ Am (are) the shareholder, partner, or member of the en5,ry that ovms the property.
���
Legalaesai{Gm
//
-aa'^T..-a
arry por ct tne reveen:ial uueure m ne IaM mt ezuca�mg me (1) ave Na: vmreair<h w
�tie C�RrY Ud¢e0 to M�uce NCOme.
d�-o5- �5 �-ia�- ooa
I hereby certify the above sia:ements are vue, cortect, arW comple:e. I x
(nurt�DeiaMStreel,tify,5&e,
Other land
Todl land Qina f plus line 2)
Residentlal improvamenb or Dwellinq
Annualty Assessed Mobila /
ManuhctureE Homa ��pa
ONerimpmvemenb
Total improv¢menb (line 4[hmugh line 6)
Total value (line J plls line ])
I hereby certiry Ne abova is we, correc4
�
�
�
�
�
�
(8)
54�� alASSessw
J
(
��,�,ec, �r �m
(IY(fGH
Pase
IsNepmpertyinquestia¢ '
❑ Rwl VoPorY ❑ Tmivly astezscM moYe Mr..e (H
rtwws vut z�ucure c usM m P�um'ucme. dewiCe ine use ano
. g� � "�� 7
tlaimant vara5n9 a
� Yes [I No
. • w .. n � —
20 _ pay 20 _ Lesser of 60% ot Ne assessetl vrJUe of the hanes:ead ar 545,000
No;wiNSantliry any othei provivon, Ihe wm ol Ne tletluc(tons provided in IC 6f.1-/2 ro a rtrobile Mme 5
Nat is rro[ assesmd as real pmperty orlo a manu:aGUred ha+ie Naf is rrof assessetl es real property may
irof exceed on�haH (1R) o/Ihe assessetl value o( tAe mob7e hane w manufaGUred hwne.
DISTRIBUTION: Ongwl � Cqunry AWitor, FJeSlampeE Copy - iazpayer
1
GIBSON COUN
+� �9^� (++�u'f.h �Y.`Ye�
//� �� J
�P,
�