Homestead_Page (5)\
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
Sfale Fortn 5473 (R72 / 6-09)
Prewibed by the Department of Loral Gwemment Fnance
FORM YEAR
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INSTRUCTIONS: See reverse sitle !or filing inshucGOns. -
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I(We) ce t I(vre pied as my (our) prindpal
place of residence or am (are) buying following described real property fa vfiich a Homestead PropeA���V aion is hereby daimed
under mnVact on the date Nis application is filed, (date of filing): GIBSON COUNTY AUDITOR
❑ I(We) own ❑ Am (are) buying under recorded conVac[
❑ Am (are) enlitled to occupy as a tenant-srockholder o( a cooperelive housing corporation
� Have a beneficial interest in the Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
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Name o a'uran� (kgal n3
Sodal Seniriry nurt�6er d da'vrent (fa dg?s) Orivers license / Itlentifration /
Name ol tlairtianYs
Sodal Securiry numbrl oi tlaimanYs spouse (lav five tligds) D�'nrels lirense I ICentiflcation / Oltier number Issu'vg State
ot daimanfs spouse (W9 (rve dq/iCS)
• ••� �
tl Guying on con� Fee Simple owners rume
RecoNefs office where contratA is remNeE Recad numb� Pa9e
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���, Trnmship Ta�ung tlistrict (city, mwn, township)
PamxJ number Legal de 'P�� Is Ne P�PertY � qu��on:
� � Real pro rty � MnuaDy essessed mobile tame (IC Gf. f-n
�If any ponian of Ne retitlential swcW re w the land n excee0irg one ) aae ihal immeEiatety surtounOS Nat cnue is useE �o produce inwme, describe the use aM partion
ot the p�operry utifaeC ta produce inmme'./
� c�-/a-�a-7�-�0%3�5� oa7 �/� �0�°�0
... . . : . .
�my 7own5hiP Calnb - 7ownshiP
I hereby cenify the above statements are we, correct and complete. s nawre ot t . '
re wmber antl street, tity sfafe, and LP code)
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Land not exceeding 1(one) acre immediately ��`�+,n ,yt^�'��'{ � i`,�:�:::�.
sunoundin residentlal im rovements. (�) �:�=�� �' +<'Y"x� "` "�;°'a"
,a �'p' L'�.a:
Other land (Z) s ss, K�1 �.s�.�
Total land (line 1 plus line � (3)
Dweliin 4 <��k�� �'T.� j �����5'�2
Residential improvements or Mnualty 9 ( � - � °Y�� �� } . �
Assessed Mobik I Manufactured Home " � � '� �° ''� -`^ "`
Garege (5) ,(4Y��'"' �fin.�:.,. ;?t��?� :y;�?
"�'i1YJ•'.-u ���.'�
i =i•r --;:.f,`;�' `- :::
Other improvemenis (6) . ?ss:aMx.G'zT'
Tofal Improvements (Ilne e lhrough line � (7)
7ota1 value (line 3 plla line 7) (8)
I hereby certify the above is We, cortect, S�^a�� 01�855Of Date Slgned (rtronN, day, yea�
and complete.
Ve�ifying adion - SI9ruNfe of Auditw Date Si9^etl (mmN. daY. Yea�
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20 _ pay 20 _ Lesser o( 60°k of ihe assessed value of ihe homestead or $45,000 -
NoMit�s/andug any Wherpravision, Ihe sum o/ the ded�xtions provided in IC 61.1-12 to a mo6�e Irome tbaf ic $
rrot assessed es real properry w fo a manufacturad hwne thef !s rot assessed as real pmperry may rnt exreed �- �
ona-haR(iR) W the assessed ralue o! fhe mobtie frome ormanWaUUiad harie.
SignaWre o(PUtlitnr
Date signeA (month. tlay, yea�