Homestead_Bryante"'" CLAIM FOR HOMESTEAD PROPERTY TAX YEnFt
;,_ . � STANDARD / SUPPLEMENTAL DEDUCTION Hc�io�
Sbte Porm 5473 (R72 / 6-09)
�° ,�„ 1 Prewi�etl by Na Depariment of Laal Govemmenl Firiance
INSTRUCTIONS: See raverse side lor filing insln�clions. '
� M�e) certify �hat I(we) occupied as my (our) principal
place of residence or (are) buying Ihe following described real Pmperry Tax Stan�J��u��ereby daimed
under conVad on the date this a liration is filed, ��
pp (date o/filing): v
❑ I(We) own ❑ Am (are) buying under recorded contract �IBSON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing wrporation
� Have a benefidal interest in �he [rust or the nght to occupy the property under the terms of a qualified personal residence Wst
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Name of daimant ( n )
Sod2� Seaudy
�'
Name of daimani's spouse (lepal name)
Social Sewriry numGU ol tlaimant's spouse (las( five dipifs) DriveYS lurnse / IGentificaGOn / ONer number Issui� Statc
of daimanCs spouse (las! five dgds)
• ••� •
1f buying on cantrac� Fee Simple owneYS �me
Rem�defs alfire where mnVaa is rervrEetl Remrd number Page
..�. . � . �
Counry Tavnship Ta�drg Eistricl(ci(l: fown, fo SfiiP) � )"j�
�`
P�3yJ� I/ry._�mb/er L al desttiption Is Ne peoperty in ques
l/� �Y/�� "' al PmPertY �❑ AnnuaM asussed mo6ile hane (IC 61.1-n
�11 any portion of Ihe residenlial sUUCaire or Ne IaM not exreeding me (1) ame thai imrt�eCia[ety surtountl at sWCWre is used ta p�odure i�ne, desuibe Ne use aM portion
af Ihe pmperty utif¢ed tn P�oCUCe inmme.
I
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Caurrty Tawnship Caunry Tmmship
I hereby certify the above statemenLS are we, correct and complete. �°�'�"i_ �
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AOdress (number aM strcet, pry, s�ate, entl LP
S �
,. . , . ., . .
�, . . '
Land not exceeding 1(one) acre Immediauty �'ti:-� p� z"s "�'�4�: ���';.=
surtoundin residential im rovementa. (�) �°� # ���-'�s.. � �:
Othel lantl (2) '�k:�:u ��"r��:� �
W+.,,....s:-..�
Total land Qine 1 plus line 2) (3)
x � 1T �"�;v.i-rN.
Residential improvements or Annualty �e11ing (4) �''`� �'��5���� � � ���""�
Aucssed Mobile / Manufacturetl Home Gara e ��'A' �' "`�� "�� ��i
8 �5) '�'�`.°.s��`�^�,���''�rb �:I`*-G:
. ..�E j•:�:
Other improvements (6) ��.:�:;;��;?,Tf ��'t�
Total Improvemen� (Ilne 0 Nrough Ilne 6) (7)
Total value (fine 7 pl�s line 7� (8)
I here6y certify ihe above is We, cortect, Sigranire of Pssessor Date signee (month, day, year)
and complete.
VaiM�9 acUOn - 519nawm ol Audtw Date signeC (rtronN. daY. Y��)
� . - � • � • �
20 pay 20 Lesser o( 60% o( lhe assessed value of �he homestead or $45,000
Natwi(hstardirg enY �er0��s�, the wm W the deduclions provided in IC 6-7. i-f2 to a mob�ie lame IAat is g
rot assessed es ieel yoperty w to e menufactured home fhet is rot assessetl as real properry may rrol excee0
H�iR)WNea ueWNemobile�wneormanulacturedhome.
s raud�wr oa�:�q (�m. e-v, y�7.��
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