Homestead_May (2)I�
" CLAIM FOR HOMESTEAD PROPERTY TAX
S,;__�,' � STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 609)
� � Preuribed by Ne Depanment of Lnml Gwemment Rnance
INSTRUCTIONS: See reve�e side for filing ina(rucfions.
�� YEAR
FORM �''"�
HC10
� $�
I(We) � f certify that I(we) occupied as my (our) prindpal
place of residence or a(are b'ng Ih i Ilowing described real property for whi a H stead Property 7ax Slalrqa[dBD� ucyp�hereby daimed
under mnllact on the da e lhis ap IicaGo i filed, (date o fil g): ��� '�
❑ I(We) own ❑ Am (are) buying under remrded conVact
GIBSON COUNTY AUDITOR
❑ Am (are) enUlled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefidal interesi in the Wst or Ihe right W occupy Ihe property under the terms o( a qualified personal residence Wst
Vame (lepal name)
iodal Seariry
If buying on conbacc, Fee Simple mmefs riame
Recordefs otfice where mntract is remrCeE
f i A � _ Tovmship
omers r�� � m�tir,��
of da'unant (lasf frve d'gifs)
Dmefs license I Identification I ONer number
of daimant's spouse (lasl (rve d+gdsJ /� /,
tl any portion ol ihe residenlial swcWre or Ne WM not exceeding me (1) aue thai immediately s�
ot 1he pmperry WTaed m poduce inmme.
•�• • �:
CaumY 7ownshiV Cwnry
I hereby certify the above stalements are We, cortec[ and complete.
Address (nu
�
Land not e'
surtoundin
Otherland
ciry, sfete, aM LP code)
acre immediatety
Total land (line 1 plus line �
Dwelling
Residential Improvemenb or Mnualty
Assessed Mo6ile 1 Manutactured Home Garzge
Ofher ImOrovemenb
Total Improvemenb (lina 0 throug� lina �
Total value (Ilne 3 pl(s Ilne 7�
1 hereby certify ihe above is trUe, cortect,
and complete.
✓sifyifg action - SignaWre ot Audtor
i�)
(2)
(3)
(<)
(5)
(6)
(8)
afASSessor
Remrdnumbu �Page
pmPenY in Gues6on:
�al property ❑ MnuaOy as5e55ed mobile home (IC &7. t-n
Ihac swcWre is used to pmAuce inmme, Ceusibe Ihe use anE portim
20 _ pay 20 Lesser o( 60% ot ihe assessed value of the homestead or 545,000
Ablwilt�siarW4g anY �erproHSion. Ihe sum o�the deductlansWOVitled in IC E7.1-11 b a mobi7e lame ihaf is
not pssessed as real properry or ro a manuferlured horrie fhat is not essessed as ieal property maY �� excee0
...,dL�Hirni �r�n., ne�ecan vaWe o� �he rtnbde frome ormanWarturetl �ama.
S
Tavnship
Dafe signed (mOnth, tlay, yea�
DatE signed