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""" CLAIM FOR HOMESTEAD PROPERTY TAX
S ._,. STANDARD / SUPPLEMENTAL DEDUCTION �
State Form 5473 (R72 /bO9)
�O � Pfasrnbed by Ne DepaMment of Lo�l Gavernmenl Fnarce
INSTRUCTIONS: See reversa side !or filirg insUUCtions.
FORM YE�
HC10
� �
, • _
� 0"�e) cerfiry Nat I(we) oxupied as my (our) prindpal
place of residence or am are) buying ttie following described real mperty for which a Homestead Properry TaR-Sbodartl DGd�CCfon is hereby daimed
under conUaG on Ihe date this a �pGon is filed, �� ��6µ ti
pp�� (dateo/filing): � J
❑ �(We) ovm ❑ Am (are) buying under recorded conVaa GIBSON COUNTY AUDITOR
❑ Am (are) enliUed to occupy as a tenant-stockholder of a cooperetive housing corpo2tion .
� Have a benefidal inlerest in ihe wst or the right to occupy the property under the tertns of a qualified personal residence trust
•- � •
Name ot aaimant Qeg .
Sodal Seamfy
Sodal Security riumbu of tlaimaM's spovse (last fiue tligits) Dm�ers Gcense / Idenlifxation / Other number Issuing State
of dairtam's spouse (last I'ive dqi6J
• ••� �
If Wying m wn� Fee Simple rnmGs `ame
RecoNefs ofice where rvnVact is recordeA � RemE ruimbu Page
..�. . � . �
� TOwnShiP Ta�m�g d�stri<] (rifl: Mwr4
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P numbe^r /.�^ Legal d�iptia�n'7�q Is Ne perty in question:
��'� � O�—V�— QO . 5 a! V c� � wl PmVertY ❑ MnuaOy essessed rtrodle home (IC &f. f-7)
tl arry portion d ihe res0ential sWCW�e a the IaM not exceedU�g ane (1) arle Nat immeCWtety su�mu�MS that sWCN�e is used lo pmdum inooma, desvibe Ne use artl portion
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... . . : . .
Counry Township Caunry TowfaNp
I hereby certify the above stetements are we, correct and complete. �9^a�re ot da' m � �
Maress (� berandsvee4 c+N atate, an0 cadel ('� /�/�� by'eCi
%� �G �O-w"'� OYtI ��
,. , � . .� . �
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Land not exceeding 7(one) acre Immediatey t.'"r'ry''� �f��y°�''�.iak
surtoundin resiAentialim rovements. (7) • 3;��°s��'�'T � ��-F ,L�:�.�c
Otherland (2) ���yy�^��':.L .; •�"$ .
Total land (line 1 plus line 1) (3)
Residential Improvemenb or Mnually �����9 (4) y;�� �����f>?'���-� T�
Pssessetl Mohik / Manutactured Hartre Gare e ' ( ) � ��`�t,'+�+r"�rt �.°-��. " "' �� �?'� 5�'S'i
9 5 ft.:sn`" � �n�'�.^.c�"w''t�3ER;`iY�
kl.i �'=s�.
Other ImProveme� (8) :� F; u�y;:','�',.^--'�,_z..:t .
Tofai Improvemen6 (line 0 tllrough line � (7)
Total value (llne7 pl`c line 7� (8)
I hereby certify Ne above is we, correa, Signatura ofassessor Date sgned (month, day, year)
and complete.
Vaifyin9 ad'an - Sigrabne o1 PuQtor " Date signed (rtronfi. EaY. Y��)
� ..._... . . . .
20 pay 2(1 _ Lesser of 60% of the assessed value o! the homestead or $45, WO
NoNnt�slerMing enyWerprovisi�n, Ne samW Ihe deducbbns piovidM in IC 61.1-12 W a mo6�e fpme that is $
rot essessed as �ael property or fo a menufaWied home Nat is ra! essessed as real propeAy may not exmed
) d Ne a hre W moDde Awna wmznufarluretl hortie.
W ol ' Date signep'(q�, da� /� '
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