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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` Slate Fortn 5673 (R8l 7-07)
� Prescnbed by �he DepaMieM of Local Gwemment Finanoe
INSTRUCTIONS: See rewrse side lorfiling instrvc6ons.
� FORM YEAR
�/ . H�, 0
^ 7
1 /
I(VJe) 0 certify that on tn—�. y1 �st day of Mar , 20
I(We) o¢upied as our prind I ace of residence the fdlowing described real property fw which a Homestead Property �c'C� �� daimed:
� �J v
�(We) owned ❑ buying under contract GIBSON COUNTY AUOITOR
rlave a benefitial interest in the entity �hat is liable fw the property taxes on the property and Nat owns the properly or is buying under a contrad.
rc wyma a� w�vaa r-� smpa o�ra ��„a
Roc«defc olfice where
Counry
Parcel number
Tavnsfilp
Legaldescriplion
(ci(y, to:vn.
IS Ute property in
Ii any porlian of the residerNal sWCWre a Ne land nd ezceeding orre (i) acre that imm�atety wrtounds that
at Ihe propeM wOzed tu produca inmme.
a�-�a-�� �� ��o�-oa�
Reurdnumber IPage
al property ❑ Mobile Fbme (IC 6-1.1-�
is used W pioduce inwme, descriDe Ure use and pwtion
,_ , , . ., . ,
,,. .
Lend not exceedrg 1 (are) ave immediatey '� ;' " `" -�� - ' _
surtoundingresidentialimprovements. (�) " .. .
Other land � ��~ �
(Z) - �!�,'F->- _
Tdal land (line 1 plusline 2) (g�
y:� � �
Residential improvements or Mnualty �m� (4)
� •
Assessed Mobile / Man�red Home .�,:�� .� . .. ° ' ,
Garage �5� ;'-:!_,;� '
r i
y. "
QFhCf IffIPfOVBffl2tiC5 �fi� ..^:•� `': `:•.,:
Tdai improvements (line 4 through line 6) ���
Tctat vafue (line 3 phs li/re n �g�
I hereby CBrtify the above is W e, corteCt, and Signatura of Assessw Date signed (month, tlay, yea�
complele.
Vaifyirg action - SignaWre oflwtliWr Date signed (monN. day, yea�
� . - � � � • •
�Y 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser oi 12 qq 000 for 2008 pay 2009 47,000 for 2011
Homestead Valuation paY 2�� Z $
w 43,000 for 2009 pay 2010 40,000 payable after 2072 _
Signewre af �tor Date signed (monN. daY• Y��
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