Mobile Home_Wethington -.*�' FORM YEAR
.'�"`+b'� CLAIM FOR HOMESTEAD PROPERTY TAX
is CREDIT/STANDARD DEDUCTION °c '
' . . T 1It 1
%�_ state ribem Y the(Dfi Department
-
Presaibed by f)epartrrierlt of Local Govemtnent Finance '.,
INSTRUCTIONS.See tea touch br:Eng rrlttbuctions.
;*tea _ - -e l4: .T ^ t"' a' CERTIFICAi1ON STATEMENT$r i�r_'•?"�j AN-Lids Ot2G 6,1�-4 `+ f*i' '. "'�".,
$,�+_EF+ (�:.�\/g/'►1 -�xXXS__ "�ors"'��tu�,='F. . +:� . ..
I(We) ♦ Y L c��a��//rruu//fw�fv that on st day of March,20_
I(We)occupied as our prim I pla residencethe fo 'ng described real property for which a Homesfearto N rtyY AUDITOR s hereby claimed:
❑ I(We)owned ❑ Are buying under contract
GIBSON
®T Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
ilci;,�_ .fin•-" e 3".y ..3'- 4l:r1eJi'i 'y'if�,'.1iCONTRACT;RECORDED�'pa`.se�.Wdar .t-...-., sle'-'�r.f_ i' -
It buying on contract.Fee Simple owners name
Record number I Page
Recorders office where contract is recorded C. "sue
z -flaw
- - = =t 3-'. Yam' 7P,ROPERTY DESCRIPTION r -
County Tavnship Taring district(city,town,township)
( 5 Legal de Oen Is the property in question:
1 Sin..rf p38I-c90 /s
I,a CI Real property Mobile Homo(LC.61.1-
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to oduce income,describe the u and portion
of the property ubT¢ed to produce income.
.t, l .... T a _T. _ _
_ ZPROP.ERNOWNED�BYCL'AIMANTtIN.OTHER'000NTIES ,., 'E ` .,, Ta
County Township County Y Township
I hereby certify the above statements are true,correct and complete, ign ritclaimant
dress(numLerand s. t.city,state,ZI e) �� 1 l / i/ ,6 7
0 ��
ri t,
SSE tR USE ONY X 'r�, , ,TRUE 7AX r ASSESSED VALUE ,�v'+HOMESTEAD NONRESIDENTIAL ,,...,
.: ca=s.'uw_uw.ri:.. .114.:Sr"!y;• A.3 VALU4.z- ;?sii AT{100%.OF. V-bats-,VALUE�u: C `°tsx�ALUEw"'� k.
Land not exceeding 1 (one)acre immediately 1* '',#� .�+} .w
surrounding residential improvements. (1) lai a "s,`.`g „"-+t_'_ r sII
...c'ems ,` t_..
Other land (2) i*�-y `�
Total land(line 1 plus line 2) (3)
Dwelling (4) , -�' 3 �a�
'Residential Improvements or Annually r ��.�rac < -
Assessed Mobile/Manufactured Horne Garage latr(6) t ,._.¢ , c- '^'
Other improvements (6) *4'' c''t f
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (5)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor (la
Date signed
galprnfR Se4;:ti' ealT '` 0i.'+ FrSt.',..S ANDARD.DEDUCTION'AL'COWANCE:t' ,:EA*"t,;•" -s*''9±":`'a- �s&---It. -,?`4e a.
tA\ 20_Pay 20 L\ n
Lesser of 1/2 Homestead \\ \ $\11
�` violation or S35.000 1`1
Signature of Auditor Date signed