Homestead_Witherspoon CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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i'a,--e. STANDARD I SUPPLEMENTAL DEDUCTION FORM
‘--= Sled Form Son(I�t.hl�n.,1-is)� NCI -
� ThasQAed by rte Dec t...td tan Conran Rmce i
INSTRUCTIONS See reverse side forfralg instruction
NOTE Telephone,Social Searle%driver's home,daGe iderdiacethon and federal identicadon numbers are rxjrtthnlial inter IC 6 . -1
I(NE) v cer0y that I(veE)omupied as I 17
Ind of residence a am(are) the foaming described real property er contract fawhidt a Homestead Property Tax Standard
Deduction is hereby dammed m the date this application is signed, (date of signature) (We):
❑ Own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to ocatpy as a tenant-stockholder of a cooperative housing corporation. GIBSON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property wider the terms of a qualified personal residence trust
❑ Am(are)the shareholder, partner,or member of the entity that owns the property.
-
Cant Township Taring that(cry,town bernlp)
.
Peed matte rp
Lags desottan I Is the pe n a ly quno
❑Red prcpetty ❑Ansley assessed nos now(IC 6-1.1-1)
assn Parr a se rediardal aware or ere land nib exce ring or (1)are V.naneiayy anoint ton dnwre is reed n aodree mane,&same the use aid pans
den downy Slued b produce inure.
0200 ( $-24 -204- oo0 . CID - oa(v
-c. - PROPERTY.OWNED ELSE'dRIERE BY CLAIMANT- ,..- ,t -
Res Candy,and Tow: tp Is claimant vacating a homestead?
❑ Yes ❑ No '
of dawme
I hereby catty the above stateneiis are true,cored-and complete. `,��
SI..._- . -. .-..(nrnnmermtlseset rib:sate,antl ZPwm) a,nted ,a any are ay,Yale,and ZIP code)
■ wl 3. PW Si i. - ' en- ; .
ya ASSESSOR USE ONLY . : _ ASSESSED VALUE_ 1 HOMIES?EAD VALUE __, ,- . NON ESIIDENTIAL _ -
Land not exceeding ore(t)sole Immediately (d-- AA.-4
snovundmq residential Improvements '(1) _ 4:s.:4i a r:F.'
y c
Other land (2) -? ... _E .'.>_..`.._.._....-
Total land(line 1 plus fire 2) (3)
>a '!r s3 s„
Residential h, aev.,wrrts or Dwemrg (4) t r ,
annua0y assessed mo0 is/ - 4 :.-L
manufactured home Gangs (5) 12_ .,4. K- __._._417:
ss M grey
._
Other Improvements (6) e�r c_. ..-,:-I_._G.+,..!_
Total Improvements(line 4 through line 6) (T)
Total value(line 3 plus fine T) (8)
I hereby certify the above is true,correct, Sibre of Assesses Date steed(rtmtl;day,year
and complete.
Vefyrq ecton-Signatn dAUdmr Cod siyi d Onset day,year)
STAIJDARD DEDUCTIOkd ALLOIVAWCE;' -
20 pay 20 Lesser of 60%of the assessed vain at the homestead or$45.000.
Naasdrffince g any other provision,the sun of the deductions provided in IC 61.1-12 to a neLlie home $ --
that Is not are d as coal properly or to a manufactured home that is not assessed as seal properly may
rnt exceed ( of the assessed value 91y the noble bona or manaactm d hone.
SipeandNrEnr
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DISiTRIBVriOtt Od6'va-CaaayM,,Ra9a,9ed Copy-Tapayer
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