Homestead_Neyhouse (2)r '�
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ab
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
, _ � STANDARD / SUPPLEMENTAL DEDUCTION
Slate Fortn 5473 (R72 /6-09)
�O � Presvibed by Ihe Depanment M Laal GovemmeM Frence
INSTRUCTIONS: See raverse side /or filirg insfiictions.
�� P,a
FORM YE'�
C1
� �
� M�e) certify�E��oc� ' as my (our) prircipal
place of residence am (are) buying the
: GIBSON COUNTY AUDITOR
I(We) own ❑ Am (are) buying under recorded conUact �
❑ Am (are) entilled to ocwpy as a tenant-stockholder of a cooperative housing corporation .
� Have a benefidal interest in Ihe Wst or the right to occupy the property under ihe tertns of a qualifed personal residence Wst
E'-�"�'�'...r:�
tl Miying an contra[c, Fee Simple ownels rama
RemNers ofiice where mnvacl is recordeE
Counry
Drivers ticense! Idrntlfraf
of tlaimant (IasY frve dgiGS)
o�rs r�� i ieenarrauw, r aner �wmcer
or a��m�s sro�se cws� r� d�ra�
-us''1UD-UU H. w � s -ua �
uonid, ur ure asidentia� swcwre «ure w�a n« exceea4g
P�PanY wT¢etl b P�uce income. .
Caunry
Township
Recortl number
to»n. townsni0) •
PaBe
• Is Ule plOpPlly in Qtl¢SiiOfl:
� Real property ❑ MnuaOy assessed rtaW1e home (IC 6f.1-:
) aoe Ihat immediately surtountls Ihat strucWre is useC m produce Inoome. deuribe the use aM portion
Counry
I hereby certiy fhe above statements are we, corred and complete. 5 ture al daimam
f 0,+.�q-Il�r t�� �(Y�ni
AdM�ejslnumberardstree;dy,atate.antlLPCOUe) _ _ V `�—
land not e:ceeding 1(one) acre
Otherland
Total land (line 1 plus line �
orMnually �Iling
nned Home Garzge
Other ImprovemeMs
Total improvemenb (line � Nroug�line �
Total value (Ilne 3 pl� line 7)
I hereby certify the above is We, cortect,
and wmplet¢.
/eiNin9 action - SSnature o(�tor
��)
(Z)
(3)
(4)
(S)
(6)
�8)
ZD pay 20 _ Lesser of 60% of the assessed value of �he homestead or $45,000
NoKVnstard"ug eny oNerprovision, Ne sum d Me deduclions proHdetl in IC 67.7-77 ro a mob0e home Nat ls $
mt essessed es real poperty w fo a rrenufecmred frome Nat is not esaessed as rael properry may rro! exmea
oreJ�anl�rz� ame assessee vah,e a u�e moeile nome o� nvnulaeurea nome.
sgrav� ma,euor
Date signed (month. daY• Yea�
oate se�ed (month, ear. tea�
s§�e0 (mmfA, daY• Y�