Homestead_Snapp 4 °a. CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
STANDARD/SUPPLEMENTAL DEDUCTION HCRo
,�, % ;.25 -ted c, ezal-re -_; �-.e_-/rent= once —.._
INSTRUCTIONS See reverse side for filing instructions
NO TE Telephone Social Security drivers license state identification and federal identification numbers are confidential under IC 6-1 1-12-37.
CERTIFICATION STATEMENT
1M��������)� ,�re cert fy Mat I(we,occuped as my bur'.principal place of
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I i4ve1 L�IrC:T�+ 1
res-derce Cr ah-(are,b.:y3ng the follo.v:ny des::ceo tee prcpeny-order_crtra:t br a Homestead Property Tan Standard Ded.rt:cr s heresy cyamed or the
datethe apphcat;cr.s s gned rotate o.s.gnature) •
A. a-o y.-g urdet _:arced contra:.
0A'r f are a:-tiled to occupy as a sera^:-stockhclder of a cooperative boos rig cords a:.r
❑Haoe a berefca,.nterest in the trust Cr ire right to occupy the property under the terms of a a,s feo ce-so--a'-es-de^oe:^_st
Am;are,the shareholder panne or member of t-e entity that owns the property
• 13 J-fro or Cont-3ct tee S mole Owners Name
Reccders O'!.ce!:,`ere Scrt-act s Recorded _ _ ..—
PROPERTY DESCRIPTION
Court', . Tcwns"ip ...-.._. •_.•. ._.. ^p,
11750n 02 Pe . "To von s1,.4-e
Ra•ce,\ur oe' Lena:Jescnptcr e _
_ :.rest or
..11�35.•3W W'' O_ Dal g-aa = -noun ❑srm,alr Assessed!.'cdie!-ar.e'Ce'r.'
3' c---c'ire res-de^bS strucL.re or the,and not erceec op ore'1 acre that r+Te5 ate sr -is that sr_ct,re s used to c'cduce,come describe the use and pod cr
. ,-' zed tc p•cd..ce rcome
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County and Township _ - •_3 rating a?o estead'r
I hereby certify the above statements are true correct and compie'a
Acd•ess-.-- - -•,...:-,• > :'' '---- .a-;- - 3.mlaer any s _c._ a
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ASSESSOR USE ONLY I ASSESSED VALUE I HOMESTEAD VALUE NON-RESIDENTIAL VALUE
• Land Not Exceeding One(1)Acre Immediately (1 j
Surrounding Residential Improvement
Other Land 2 FILED
Total Land(line 1 plus line 2) (3,
Residential Improvements or Dwelling i 141
Annually Assessed Mobile I - APR 0 4 Z04
Manufactured Home ' Garage 151 _ G/Other Improvements (61
Vh,civ
Total Improvements(Line 4 through Line 6) `"
- GIBSON COUNTY AUDITOR
Total Value(Line 3 plus Line 7) '!83
<yratre c Assessor
j I hereby certify the above is true,Correct,and complete
let fyirg Action-Signature of ALA.:, --- --- ones, .are =r. ,
STANDARD DEDUCTION ALLOWANCE
20 Pay 2C Lesser of 6C'',of the assessed._ - _ _-estea::
N0P.;3!n Standing any otner cros:s-on 'he sum of the dedc:t:drs pros des r 5-t 1-'2 - .
:s not assessed as real papery or to a ma^ufactured home Mat s rot assessed as mai
eiCeed one-half(1,21 of the assessed va'ue of the oeore home or manufactured none
S3gna^,:re of Audiror ��a.�s�'m -- - -
DISTRIBUTION- 2r;na -:-u^y,_„ _ _ S's-ret_x:--arzaye•
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