Homestead_Brown (6)° CLAIM�FOR HOMESTEAD PROPERTY TAX ' FaR�� �yEqR
• _ y � STANDARD / SUPPLEMENTAL DEDUCTION
:�' Sa:eFamSa]3(R15/&td) '
, 7resrnbed Cy Ne Oepa�.ment ct Local C veervrcrA G'marca
INSTRUCTIONS: See 2verse side forlllna inshvctions. i
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NOTE: Telephone, Sacial Secunty, tlrivefs /icense, sfale i0enli:.ra1"qn end fede2l itlenlificafion num6ers are confitlenUal un0er IC G1. f-1¢-37.
I (We) . � � - � . . � ify that I (we) occupied as my (our) � � al
place of residence or am (are) buyi t e followin escribed real prope under conVact for which a Homestead Property Tax Standard
Deduction is hereby claimetl on the ; ihis apP���lion is signed, (date o75i turej. I e�
❑ own. ❑ nm (are) buying under recomed wnvact. GIBSON COUNTY AUDITDR
� Am (are) entitled to occupy as a tenan4stockholder of a cooperative housing corpora;ion.
❑ Have a beneficial interest in the trust or the right to ocwpy Ne property under the terms of a qualified personal residence trust.
❑ Am (are) the shareholder, partner, or member of the enuty that o•.vns the pmperty.
i� dryin5 on con'.raa Fee s'u:,p�e owrers name •
Rcrdtlels o5a wlure mnVaq is recwtletl RemrC nun0er Paye
..ouK TwmsRO 'TaungEis:rrci(rAy,! ttyrox h )
�
PazcN w.i�er le9alaesaiG•ion �ISt' Frct��Yin xstan
—a������� I Realpoper,y ❑NnwF�asxsse0r..o0ieM-.e(ILbt.1-l�
tl a:ry paM1im o: Ne reziEen:ial zV�MUre cr p�e la:d ro� eareMap wie (1) aae WI nurc�u'sly zu �CZ Ua: zt�YUre iz uzeC b poGiu'ura�e, Gesvi�e Ne �rse aM pw n
IX C�e pvcer'/ V1aed :o o�uce �cor..e.
Sax.Gouirty.a�diwmstao � Istlaimanivap;inga�omes:eatl?
� Ye n No
Sgna:ureotaai nc
I hereby cef�fy ihe above sta;ements are Vue, corzeci, and comple:e.
AOCress d coroa (numDer arM sreeL �'+%Y ra:e, aM ZIPmEe) . �G ress ot vara:eE , , y �n suee( rny,.ca:e, ariC ZI.�wOe)
� 1b,L. .S' S .fi'�4+C���D�=�':.
LanE not ¢xceeding one (1) acre immediatety I �' '- . - - -- " -- _��I
surtountlin resitlentlalim rovemen6 (»
ome� v�e �Z� - -� . . . - - - -
I� '_,,.
Todl land (line 1 plus line i) I(3) .
Resldential improvements or D.veiling (4) � -
Annualty Ass¢ss¢d Mobile / I _ _ _ . . , , _ _
Alanufacturetl Home Ga�ge (5) �
Other imProvemenis (6) r - � �.
ToUI Impmv¢m¢nts (lin¢ 4 fhmugh linc 6) Q)
Totatvalue (line]pl�slinel) (8)
I hereEy certily Ne above is tme, correcq Sig�u:uee o�ASSessor Da sgrotl .)
anA com0�ete.
v trvs�-sm�:�reG•aw�:« ( - . . . ..n
� o.
20 _ pay 20 _ Lesur of 60% ot the assessed value ot Ne homes:eaC or 5<5,000 /� ,� I,� —
hbb•nlh5landing any uhe� proNSion, Ihe wm ol No deduc(iWris provided in IC 6-1.1-12 to a rtroWfe home 5 ,/ �L __' 11d'!�
Naf assessedasrealpropertywtoamanu(acluretllwneMafisrrotassessetlasrealprope.rymay , x[d�j'/K�S7 uTM/wK
raf rne-haH(1/J,) 01 Ne a=essed value of Ne moiv7e hwne wmanuiacturee nome. G B
Sgnr AW.ar Da• wrcE(r.vt2CaY.IYr<arl
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