HomeMy WebLinkAboutHomestead_CornwellCLAIM FOR HOMESTEAD PROPERTY TAX
__ STANDARD / SUPPLEMENTAL DEDUCTION
State Fwm 5473 (R73 / 12-09J
�,�� Presaibed Cy the Department of Local Govemment Finance
FORM
HC10
YEAR
INSTRUCTIONS: See ieverse side (or filing insbvtlions.
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I(We) certify that I�we) ocycupCied as my (our) principal
pla� of residence or am ( re) buying.the tdlowi descri reaI property fw which a Homestead Property Tax Sta �1 ue���� hereby daimed
� er contrad on the date this application is filed, (date of filing). I(We):
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Own ❑ Am (are) buying under recorded wnVact
� Am (are) endlled to occupy as a[enant-stockholder of a cooperative housing corporalion GIBSON COUNTYq'I
❑ Have a benefiaal interest in the irust or the rigM to oxupy Me property under Ne tertns of a qualified personal residence tru§�ITOR .,
❑ Am (are) Ihe sharehoider, partner or member of the entity that owns ihe property.
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Name of 'mant (kgal me)
Sooyl $¢
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Sodal Sewriry mher oF tla" nYs spouse (last (rve dig'rts) Drivers lice�e I Identlfiration I ONer number Issuing Sate
RetorEers otfice where mntracl is tecorded ftecoN number Page
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Counry Township Ta�dng dis � dty, town. to shiP)
Parcel numher Legal tlesaiptio a, � R� Is the property in question:
' ,' 8� JJ� (� . QO p. 31l •0 g � � g� a. -10 ❑ Real P�P�Y ❑ MnuallY assessed mo60e home (IC bf.1-7)
If atry portion of ihe residential sW�ture or the IaM nal exceeding me (1) aae Nat immedatey surtounds that sW�iure s used tn produce income, desai6e tt�e use aM portion
of the prope�ty utilized to protlum Inmme.
•�• • �: � •
County Towns�ip Caunry Tmmship
I hereby certify ihe above statemenLS are We, cortect and mmplete. X Sig of daima
ADdress (number eM sfieet, dry, state, aM Z/P oodej
�. �o. .� 2 7�
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Land not exceeding 1(orre) acre immedlately >�" �� �^_-,�-'-`��i ��z� �,
surtoundin residential im rovements. (�� �-���� �== " ��
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Otherland (2) �� �,�x=_
Total land (line 1 plus Itne 1) (3)
�;xY �5�°sw �.=s T e�'--s�.s�,:�`-`t
Residendal improvemenis orAnnuafty �����9 (4� �' ''�' �'� �° "` � �R � °"
Assessed Mobile / Manufa�4ired Home Gara e �x-E_"r�'��'m� �°�, � : � � >���
9 (5) s_� <: � ..,,<._ �' �.:.a,_�.>._ _ 3�.� ��
-�c 2:r:t . _
Other improvements (6) � V � � ?t. �'� �'
Total improvemeMs (line / through line � (7)
7ota1 vaWe (line ] plus !fie n (8)
I hereby certify the above is true, correct, �9"aNre of Assess« Date sipned (month, day, yvar�
and complete.
Vfrifyug adion - Si9reWre oflwdiinr �� �9�� 1�^W �Y Y��
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20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NoMithstandirg any oNerpmviseori, !he sum ol the dedudions provitletl in IC Gi. f-12 fo a rmbile Mme fhaf is $
not ascessed as rcal pioperty or to e menufacturad home Mat is not essessed as real property may irof exceed
one-hall (12J o/Ne assessed rah�e o/the mobJe fame or manufxfured fame.
Sig�hue of fwdita Date signed (monfh. day, yea�
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