HomeMy WebLinkAboutHomestead_Smith (22)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
4. s STANDARD / SUPPLEMENTAL DEDUCTION
S•. v.. State Form 5473 (R12 / 6-09)
�O ,�„ t Preuribed 6y the DepaRment ol Lo�l Govemment France
INSTRUCTIONS: See reverse side (or filino insfnictions.
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i(We � 9F ceNry �nat I(we) oca,py��// my (ou a�l .�
place ot residence r am (are) buying the following described real property (w whirh a Homestead Properry Ta: Siandard DedOClid�i`y�E�ned
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under convact on Ihe date ihis applica6on is filed, (date of filing): GIBSON COUNTY AUDITOR
❑ I(We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefidal interest in �he Wst or the right to occupy [he property under the tertns of a qualified personal residence Wst
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Nam da'imam(kgalnemaj
Sodal Seamry rc
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N f tlaimanYS spouse (legai ngm,) '
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Sodal Sewrity numbnl ot tlaimanjC ,spouse (lazf five dgrts) Drivefs lirense / Identif�ration /
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If buying on contraa, Fee Simple ownefs nama
Recnrtlers office where mntracl is recoNed Recad number Page
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���y Township T' dis d tity, rown, township)
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PamnJ number Legal desaiD�+ / Is ihe pmperty in purstion: .
' s� � Real propeny ❑ AnnuaOy assessed mobile home (IC S7. t-n
�If any portion W the residential sVUCwre w Ne IaM not exceed'ug one (7) aae thaf irt�rt�e0iaeely surtwnds ihat sWCWre is used Io produce i�arne. desrlihe Ihe use and poruon
of Ihe P�PeM wTaed lo poduce income.
a(o-/d-o5. yoo-ool. (oyo-ad7
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CouMy Township � Counb Tamv�Np
I hereby ceNfy Ne above ststements are we, cortecl and complete. si a aaimam �
�Atldress(numDeiaMSfleet,cdy,5tate,entlZlPootle)
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Land not e:ceeding 1(one) acre immediatety ' ""�'.r}�� �� ��'T� �� '
surtoundin resldenUalim rovements. (�� .,.t.�- s �7�. �y� "`d�;a-ui
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Other land (Z) CH"._a:�`: �h�"+."t�
Total land (I/ne 1 plus line � (3)
<.P� �urF-'-.,�. va-,is� €ii•
Residential improvemenb or Mnualty �elling (4) ,- � �,� _ ��€�'tf �� , 3�
Assessed Mo6ile I Manufactured Hwne --'- "�- ��"'?�>�f .'"'*"
Gardge (5) x�'t'.N��+.t'�?:k hx�z„':�'c'-
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Other Impmvemenfs (8) .;'"�'K�:';�'?� y v'
7otal improvemenb (Ilne a tAmugAline 6] (7)
Total value (llne 3 plls llne 7� (8)
1 hereby certify ihe above is true, correct, Signature of Assessar Date signed (monfh, day, yea�
and complete.
Vaifyi�g aclirn - Sigriature ot Autlimr Date signed (month, Oay, year)
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20 _ pay 20 lesser of 60% of the assessed value of the homestead or $45,000
AbfudfhsfaMing any olher p�ovision, Ihe sum Glhe dedurtions provided in IC bt.7-f2 fo a mo6de home Naf is g
rot assessed as real property w lo e menu7ertured home that is not assessed as reel proparty meY �� erceed
anahaH�1R) W Ne assessetl ralua o/the mobde home armanulaauiedhome.
Signawre W P�C1tor � Dale signed (month, day, yea�