Homestead_Rawlinsoniy.�-,`�' CLAIM FOR HOMESTEAD PROPERTY TAX � vEpR
� - STANDARD I SUPPLEMENTAL DEDUCTION FORhi� ����
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�� Pre�v:h¢C b/ � e Depaf .er.l 01 La�l Go':e. :.-cv4 Firar,ce
LVSTRUGTIONS: Sce raverse sido !o� hlbKj insfmctians. ,
MOTE: TelepMne, Sada/ Secunry, tlrivers license, sfa:e iden4rca:ion aritl7ede�al ider,u:.eation numDers are confidenlial under IC 61.142-3i_
I(We) �__! i rr p_.�a�_V�: ' we) occupied as my (our) ptino'yl
place of residence or am (are) buying ;he follaw.. g des:sibed real property under contract for which a Homes;ead Pm .� Tax Sa _ard
DeducSon is hereby Gaimed on the date .his applica;ion is signed, (date ol s"ynat e �
O�tin. ❑ Fvn (are) buying uneer rewrded convac,. GIBSON COUNT` A
Arn (are) en;itled to occupy as a tenanPS;ockholder of a coopera.ive housing corporation.
❑ Have a ber,zfi�al in:erest in the ;rust or ;he ryht :o occupy Ne pmperty under Ihe terms o� a quali9zd peaonal residence ;-tis;.
❑ Am (are) G�e shareholder, partner, or member of the entiry that owns the propery. �
c�.nels wm±
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�m ow c, a We resiamNai s:n,anre or me
L�IG'JO�d'.y�III PtltO WMUf¢�IMDrtIl.
sa:e, LwaCy, aM Tov.nst�ip
fternrtln:mec Pape
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Nepropefyinqu s
� f�!� t � Realpropef.y ,�❑ Mv:vaf�assnuWnoWefwrt�e(l�
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il aee vut r..-ieare7 w�rounCS ✓at zrveure is useE ta amvrz �rm:». aesmoe c�e se arc
Is dair.uN vaca�ng a hones:eaE
11Yez❑�o
1 swna:ure o: datrnant
I hereby certify :he above statements are lme, mrrec;, and comple.e.
P'JO255C1CWCdG(/NmGP�alW'Y�eP1,6y,Ya'P, 'MZIA(.4�e)
l�iaBa S' 91d� � �s
lantl
Oiherland
Total lanE Qine 1 plus line 1)
Residentlal improvem¢n6 or
Annuaily Assessed Mobile I
6lanufacturctl Home
Dwelling
Garage
Other improvements
ToGi improvemen[s (line a thmugh line 6]
Total vxlue (line ] pl�s line l)
1 hero6y certity the abova is Uue, correc4
and complele.
lauyiigxCnn-$gratureclPUd�tor '—
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�ex�x.r-L°t e-C�.�e�Leu�u<.a�
of vara:ea rones:eaa. C any (� ar�f s�rtrel otj. sfa:e. a:�C L�
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20 _ pay 20 _ Lesser o/ fi0%o'the assessed vXUe of Ne homesread w S<5,000
TJOhAfhsfanCinganyatherprovivon,lhosumo(ihodetluUianspmvitledinlC6-1JJ2(oamoWlohome 5
Naf is nof assessetl as real nmper.ry or ro a n, anu:actumtl hm= Naf is r.of assessetl as realproper,y may
rrol e+ceetl on�half (12) of the assessetl vaNe o/ lhe moWe homa ar manutaUUretl nome.
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OCi�2� 2015
Da:e 4qreC (nmc�. Cag i�
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��BSON CO, NU TY AUDITOR