Homestead_StrawCLAIM FOR HOMESTEAD PROPERTY TAX
:`_^�-1 * STANDARD / SUPPLEMENTAL DEDUCTION Foan7
Sa:e Form Sa]3 (R15161a) HC70
��''' Prescnbetl py Ne DepaNnent of Lo�l Gwerivnent Fnanrc
INSTRUCTIQVS: See reverse side for filirrg instmcfions.
hOTE: Tekplwne, Satlal Secunty, drive/s license, sfate itlenf�icalion aM federal idenlifimlion numbers are confidenlial�}'dZ11L$f.�
I(VJe) certify Ihat I(wEJEcaipi�tl 3Siliq (E1fIJ�riRI
place of re ence or am e) buying the f. owing described real property under contract for which a Homes:ead Property Tax Sian
Deduction is hereby dai on ihe da:e this applica;ion is signetl, (date of�n�iu�. I(t�4��5
❑ Gm. ❑ Am (are) buying under recorded contract.
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation.
❑ Have a beneficial interest in ihe Wst or Ne nght to occupy ihe property under the tertns of a qualified ��
❑ Am (are) the shareholder, partner, or member of the entiry that ovms Ne property. GIBSON COUN�TY�AII
' ' �
�(
IIs tif Woperty in Questio2
❑ aeai proa��'l ❑ nenwN assesseo rtrooae nomc (x
wrtwn0.s wt swCUre s usea m O�us'ura-ie. xsmte c�e �se am
Sa/-O d.�
20 _ pay 20 _ Lesser of fi0% of Ne assessed value of ihe homestead or 545,000
AbMiNStarHinganyolherprovivon.(hewmoiUredetluclbnsprovi0etllnlC6f.f-12loartroeilehome 5
Naf is rrof assesse0 es real pmperty w ro a manu(acfumC home Naf is no1 assessetl es real property may
rrof exceed m�hall (12) o7Ne essessed vaNe ol fhe moDde Mme w manu:acTUred home.
5gvmreofNC�w . _ . �`
Is daimant vacaLng a homesteaC?
❑ Yes Q No
ay, sa:e,
Da•s synea (norn, tlay,
zgreE (mm•k aay, yee�
I
OISTiUBUT10N� I-LarGyNUtl'.tar.FieSa:��r.MLOpy-iamaYe�
I I V �I � — I � � /7 ✓ L� (i� iM�- '��T M".-„"�� '
u �