Homestead_Gonzales�'"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ ?; STANDARD / SUPPLEMENTAL DEDUCTION
S State Form 5473 (R72 / 6-09)
�� � Preuribed 6y ihe Department of Local Governnienl Fi�nce
INSTRUCTIONS: See reverse side !or fifirg insLuGions.
��
FORM YEAR
�' I �
I(VJe) \ at I(� pied as my (our) pri�pal
place of residence or am (are) buying the following described I property for whi Homestead P�o�� erd uaion is hereby daimed
ufwer convact on �he date �his applintion is filed, ( are olfiling): GIBSON COUNTY AUDITOR�
❑ I(VJe) own ❑ Am (are) buying under recorded conV2ct
❑ Am (are) entiUed lo occupy as a tenant-stockholder of a cooperetive housing corpora6on
� Have a benefidal interes[ in Ne Wst or the right to occupy the property under Ne tertns of a qualified personal residence Wst �
Name of daimam (bgal name)
� of ciaimant (lasf (rve tligiLS) � '
anfs spouse (legal name)
Social Secunry numbu�ol tlaimant's spouse (Ias1 five tligrts) I Drivers license / IdenGficatbn I ONe
� � �„� .� ot daimanYs spouse (lasl frve d'qitsJ
If buying om m�Vact, Fee Simple owners name
oRre where tontract is recoNeA
Caunry
(ciry, rown, fownship)
State
Recad number
Page
P n ry��[ r //�y�� ahld p' IsNep�opertyu�Westion:
1��� O� I DI � VV �� J �V� �. ❑ Real DroDenY ❑ AnnuaOy assrssed rtnbile home (IC 61.7-:
tl arry ponim of Ne �e.tidenilal sWCwra w Ihe IaM no1 exceed'ug one (7 ) aae ihat "unmeEiateJy surtounds Ihat swcaire is useE Io proAUce iMOme, describe the use aM portion
of Ne OmPen1' utS¢ei m produce income.
Counry
Township
I hereby cenify the above statemenis are we, correU and complete.
et,al};
w.
LanA not exceeding 1(one) acre immediatety
ONer land
Total land (line 1 plus line �
Residentlal
Assessed N
Dwelling
Garsge
Other impmvemenb
ToUI improvemenb (Ilne 0 fhrong� fina �
Total value (/ine 3 p/�s Ilne n
I hereby certify ihe above is true, cortect,
and eomplece.
Vaih/irg acem - Signature of Auditw
(�)
(3)
(4)
(5)
(6)
�)
(8)
Sigriature of Kssessor
Counry
at
Date signetl
(monN, daY. Y��
20 _ pay 20 Lesser of 60% of the assessed value oi the homestead or 545,000
NW�.WhsteMirg eny N�erprovision, fhe wm N Ne deducliuru prwidetl in IC 67.1-1Y to e rtnbde frome Nat is g
rpt essessed as reel properry w ro a manulacturad frortie fhat is not assessed as reel properry meY ^� esceed ' "' "
ona-hatl (fR) d Ne assessed valueW the mobde home a manufadured hwne.
Signature of PLCltor Oate signeC (mmd�, day, yEa�