Homestead_Heidenreich Farms Inc.-I�
CLAIM FOR HOMESTEAD PROPERTY TAX
. __ � STANDARD / SUPPLEMENTAL DEDUCTION
- '. � Stata Fortn 5473 (R73 / 12-09)
�,�� ! PresaiDatl by the Depariment o( Local Garemment Firaxe I 1
INSTRUCTIONS: See reverse slde /orfiling insfn�ctions. �Vj�j
FORM
I(We) ceAify that I(we.`),��ed �as my� (our) prindpal
place of residence or (a 'rg the fdI ing described real property for which a Homestead Property Tax Standard Ded tfn Vreby daimed
er contraU on Ihe date this appliration is filed. (date of filing). I(We): GIBSON C
Own ❑ Am (are) buying under recorded conVact OUNTY qUDITOR
Am (are) entilled to occupy as a tenant-stockholder ot a woperative housing corporatlon
❑ Have a benefidal interest in the Wst or the right to ocwpy the properly under the tertns o( a qualified personal residence Wst •
❑ Am (ere) the shareholder, partner or mem6er of the entity ihat owns the properry.
C:'°1f?•.T�.°°*
spouse
If buying om m�vaC, Fee Simple owners name
Retorders of6ce where conUact
Courity
Paicel number
If arry ponion of ihe resid
aF the P�PenY utiliznd ro
� �—, 1 'O•
Counry
Orivefs license / Idenllficathn / ONer
or aa��� c�+ r� a;�rt�,
omrers &ensa � identlemtion � othe
ot daimanfs spouse (WSt �iva dgits)
/�
Reoord number � Page
Township Taring djs(rid (tity, Mwn, fownship)
1�
tL�egal tlascJq�tion � Is Ne praparry In question:
Y ❑�� o�a�r ❑ annuany atsessee mobue tnme (�c Gf. f-7)
ial structure or the lar�d not e�edinp ana (1) acre Nat immedatey surtounds ihat struceire is used to P�uce incane, drenbe the use and patirn
� o�o ��a-�a � . . � , ,
Township
1 hereby certify ihe ebove Sta[ements are W8, corred and complete.
aum6ereMstraet.tiry,sfefe.a�ny Z/PCOde) 1
��{ VJ � 00 Ai Y If 1 Jl C2.1 D
Land not exceeding 1(orre) aere immedtatey
simounEing resldantial improvemerhs.
Otherlantl
Totnl land (Ilrre f plus Ilrre Z)
ResidentiallmprovemenfsorAnnually �����8
Assesaed Mobtle I Manufxturad Home Garage
Other Improvemenffi
Total improvemerRS (line 1 Mrough line �
7oa1 vatue (Ilne ] plus une 7)
I hereby eertiy Ne above Is true, correef,
and complete.
Vaihvy aWm - SignaNre otAUditw
(�)
(2)
(3)
(4)
(5)
(6)
�)
(8)
County
ZD� � }7 (, 70
of Asseswr
tlaimant
20 pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NolwithsfenUing eny oMer provision, the s+im a/ the deduc(ions proNded in IC 61.1-12 ro a rtoW7e home Nat is $
not assassed es reel pioperty w to e menufacfurad home thef is ra( essessad as reel p�operry maY rat axceed
MMiIA/�/1/lIOIf/IBBSSBS58f�VB�IIBO�i�IBlIq�B�IORIBWRlBlIU�8fi1/lBl�:IOTB. __ _ _
Taxnslup
si9netl (monM. deY. Y��1
(monm, eay. rea�
(month. day, yea�
�