HomeMy WebLinkAboutHomestead_Evans"' CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R13 / 12-09)
t ! presaiDeE by Ihe Departrnent of Locai Gwemment Finance
FORM Y�R
HC70
INSTRUCTfONS: See reverse side !or filing insbvctions.
. .
I(We) � • certiN that 1(we1 �w as my (our) princiPal
place af residence or am (are) buying.the following described real property fw which a Homestead Property Tax Standarcl �iC§'on�ere¢Y daimed
er contrad on ihe date this appliplion is filed,
(date of filing). I(VJe): v V
� p�y� ❑ Am (are) buyirg under recorded contrect GIBSON COUNTY AUDITOR
� Am (are) entilled to occupy es a tenent-stockholder of a cooperetive housing corporation
❑ Have a bene5cial interest in the Wst or ihe right to occupy the property under the tertns of a qualified personal residence Wsi �
� Am (are) the shareholder, partner or member of Ne entity that ovms ihe property.
e �• . •
Neme W daunani (kpal na
Sooe1 Seaaity
SmJal Smriry numher of daunanYS spouse (�asf five dgiGS) Orivers fice�a / IEan4fxation / Other numher Irnnng State
ot dainwnYS spane (lasf five dig2s)
� �'� �
If buying an contra4 Fee Simple owners name
Remrdefs of5s Wiere convaG is remrded Remrd number Pege
..�. . � . �
Counry TwvnshiP Ta�dng '(ray, Mwn, rownship
Parcr� iwmber Legal tlesaiption � //s/, � � -7 Is the property in question:
7.bCi�i- { ❑ Rea� propeny � annuaoy assessed mmue nome (�c G1.1-7)
o(t Ne �� �utili�d to��al sWcWre w the Ia�M not exccetling one (1) a�re that immed'utety surtounds that strucWre is used to pcoduce income, desaibe ihe use and portbn
P�rtY P�duce Incane.
�-�a-ig- 30� -�o. ��a�-o�.�
-.. . . : . .
Cwnty Trnmship Counry 7��p
I1 hereby certify the above statements are We, correct and complete. g"j� °f daimant
f �
X AtlOress(numbereMStreef.dty,s7ste,aMLPOOda)
50 �� �r� c 7G%�
�_ � . . .. . .
�� ..
Land not ezceeding 1 (orre) acre Mmediatey - - � �* ,Y : �_1 �, �"'*s�a _�
surtoundin resldentialim rovements. ��) �..:_.�,� s`?�„�_:;;,;,u �«-���y`'�
Other land (Z) -a�,.° "7 .r .: �'"'� :'.
3 e.,i-� ��!- -
Total land (lirm 1 plus Ilne 2) (3�
Residendalim Dwelling (4) �..4r,�r� c'�"��-�� '•�'����t d:
provemenfs orMnually �,. a. � �m--r�� -.
AsseasedMabtle/ManufxWredHome ��9e (5) ��.1'.g''`$J�:",�`�� �'-`"�`�'�.--'
�. r, ;.�f -� ��',s..�_
Other Improvements (6) �t ':�'-.-'` e'��,'+3i '
=£�.- :,�,--
Tofal ImprovemeMS (line / fhiough Gne � (7) .
Tofal value (line J pf1s llne 7) (8)
I here6y certify the above is We, cortect, ��re of Assessor pate �yr�d (monm. daY y,ea�
and eomplete.
Verifying atWn - Signature MAuditor Oate sigrced (rronLt. tlaY. Y��)
� • • � � � • •
20 _ pay 20 _ Lesser of 60% of the essessed value oi the homestead or $45,000
NaMithsfarding any dher povision. Ihe sum oflhe deductims provirled in IC 67.7-f 2 ro a rrqW7e home Naf is $
not essessee as real ploperty or to a menufactured home Nat is not assessed as real property may mof erceeC
onaeeu 1rz1 wu,e essossed venre aure � hw,re ormanttlacbned noma.
Signahue ofiW Citar Date SrtJned (monfh, day, yea�
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