Homestead_Heidenreich Farms Inc."" CLAIM FOR HOMESTEAD PROPERTY TAX
<__ STANDARD/SUPPLEMENTALDEDUCTION
� SFata Fwm 5473 (R73 / 12-09)
� yw I Presaibed by the Department of Loral Govemment Fina�e
INSTRUCTIONS: See reverse side lor filing inshuctions. �p �� n�S
FORM
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I(We) � J � I certify ihat I(we) occvpied as my (our) prindpal
� �� �� areb daimed
place of residence w am (are) '�g the fdlowin9 descri I p operty fw whi Homestead Property Tax Standard Ded ' m'�sT � y
�er contraU on lhe date this applicalion is (led, (date ol filing). I(We): ��
pwn ❑ Am (are) buying under recorded contracl GIBSON COUNTY AUDITOR
� Am (are) entilled to occupy as a tenant-siockholder of a cooperative housing corporation
❑ Have e benefiaal interest in the Wst or the right to occupy ihe property under Ihe terms o( a qualified personal 2sidence Wst .
❑ Am (are) the shareholder, partner or member of the entity that owns the property.
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Y 1 nit ,r 1�--,si � � � ,�` -,r � �-��+'�.:�' r�i
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of daimant (lasl five d+gifs)
ot daima�rs sPa,se (�au r�e d;yru)
�' � I Issuirg 9ete
Record num6er
T
, V
Peqe
n�T'J-7��W���TI'�/�`� IIS���W�P�nY �❑MnualyassessedmobOeMrre(IC61.1-7)
�ortion of tice residential sWCture or tha IarW nol exceeUing one (1) acre that immediatey surrountls ihat sw�re is used tn produce'vicwna. Oewiba the use and patbn
xopenY u6faetl m produre Inmme.
Counry
Tow�vsMp
Counry
I hereby certify the above staiements are We, correct and compiete. I signature ot daimant
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cif}; staro, aM ZlPmde)
/ 20o h
Land not exceetling 1 lorrel acre
omg. ia�a
Totei land (lirte 1 plas line 2)
Dwelling
Ga2ge
Other Improvemenb
Totel improvemerRS �line 1 through fine 6)
Total value (lirre 3 pl�a line �
I hereby certify the above is tr�e, correct,
and eomplete.
Verilying adlon - Sigrcawre of Audimr
� , n c.a..'�on , -l�r✓
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cz�
(3)
(4)
(5)
(6)
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Sgrawre
20 pay 20 Lesser of 60% ot the assessed value of the homestead or $45,000
NoMifhsfem7ing eny otherprovision, fha sum o/Ne deducfiorrs povwled in IC 61.1-f2 ro a rroW7e horne fhat'a $
not assessed es real pmperty w to a menu7ectured hane Nat is nof essessetl as real pioperty maY la( exaeed
om.h»N If/11 NMe n�ewem./ �ry�Wfhe rtpWle home or mentdacfu2d fiome.
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Dam sigred (month, day.
Date 99�Gd�—V V�� /
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