Homestead_Weber (3) CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
• STANDARD/SUPPLEMENTAL DEDUCTION FORM -
INSTRUCTIONS See reverse side for filing instruct ons
NOTE Telephone.Social Security driver's license state identification and federal identification numbers are confidential under IC 6-1 1-12-37
CERTIFICATION STATEMENT
I We Mote 1Q. 11er cert fy that I i.eti )Occup ed as rry o pro PCipa place of
resderce•,am(are:t:uy�rg!re`o!!ov:ry^ddesc'bed ea.prcce-ty..__ __ a-. - •'. or a t s—re5'.ea7 Prcper!y Tan Sta-Card Deo._ s __ __, c
dateapp!cahcrssgned yis/aa =_
❑Am
❑Arr!a e ert:ced to occupy as a teraot-st c:x`c Ca:C`__ ._ _� __era=
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❑Ha,e a ce efc:a..rte'est it tr5.•st cr Ire,gr.;to:user t- c-oce-1,- de _._ _ sva a_a `.a_._sc'-a -es-deice s.
❑Am tare,the shareholder parer Or member of the ent^.y trat a:.rs ire property
CLAIMANT'S INFORMATION
Recorder s OS.ce',\`e•e Cert'act s Recorded • Pao.
PROPERTY DESCRIPTION
Co Lfrty /' Township
(� _SD n 0 ?v,--\o (ownSh:P
ca,ce,humoer s;a Cesr•pt or s•. -
f4 /1�/I-160^000 /�(�Q ^m-�`�
V�`1-0 , i Lfl4aa•Property ❑Arn;:a:y Assesszd'.'ocwe'-omz C 6,,-';
any conic,cf the res'dentia'struct.fe or the land not e.:eeo rig are".acre:rat cored ate y S rcunds that st-uct•,re s sas to reduce income Sesc-ibe the use and porter
of ire proce,1,.ut zed to produce-name
PROPERTY OWNED ELSEWHERE BY CLAIMANT
State County,and Township
❑ re_ LS
I hereby certify the above statemects are true correct and complete
ocd-ess- '.ac•.r mbar and;Veal _ - .: - -__ _—_ — - -,ass:f.acate. 'a-r roc- 7 strew
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• _ •h ► I • ► k 70
ASSESSOR USE ONLY ASSESSED VALUE HOMESTEAD VALUE I NON-RESIDENTIAL VALUE
Land Not Exceeding One(1)Acre Immediately
Surrounding Residential Improvement _Other Land FILED
TotalLan (line1plusline2)
Residential Improvements or Dwelling •-
Annually Assessed Mobile I —
Manufactured Home Garage '1
APR O C J 0't4
Other Improvements • APR
Total Improvements(Line 4 through Line 6) Yii,GfuLGC a J/Yl L im4)
Total Value(Line 3 plus Line T) --- —_GIBSON COUNTY AUDITOR
_ -_ =ssess:.
I hereby certify the above is true,correct.and complete
`ier:tyrg Action-S p at'ure of Aud to-
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STANDARD DEDUCTION ALLOWANCE
2C --Pay 2C Lease-
Not.::tnstanding any otner cros,s's,' the sum of Lie dads ctrcrs pr;;.
5 not assessed as real property or to a manufactured home!hat s as srs sa.:a_ "r - -
erceed one-half r 1,2)of the assessed vase of crre or manufactured same
Sigra7.re of A.ddo' f/5-42 L/
DISTRIBUTION g re--Count,>__ _ °-.S-3—Ze.:om.- C—./S"a
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