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"'" CLAIM FOR HOMESTEAD PROPERTY TAX /� � FORM YE�
_ d STANDARD / SUPPLEMENTAL DEDUCTION�l'�A�
� Stata Fortn 5473 (R72 / 609J U .
�O � Presuibed by Ne DepaMceM ol L.o�l Gwemmerit Fraxe �' � �
INSTRUCTIONS: See ieverse side Iwfiling insfrucfions. ' � �� � � �� �� .
I(We) 7e//LO X-U'lGL !�( [11 Ci.!_/1; .�L[//,[/!.C-/.W ceAify that f(we) ocw a y(our) prindpal
place of residence or am (are) buying ihe following described real property,for which a Homestead Property Tax Standard Dedu on' ereby daimed
���u---n���tl(((er conVaG on Ne date this appliration is filed, (date offiling): GIBSON COUNTY AUDITOR
g� I(We) own ❑ Am (a2) buying under remrded mntract .
�❑ Am (are) entitled to occupy as a tenant-stockholder ot a cooperetive housing corporation
� Have a beneficial interest in the Wsl or the righ[ to occupy the property under the tertns of a qualified personal residence Wst
of
spouse
If buying m contrad, Fee Simple ovmefs name
Remrdefs ottxe wMre mnvaG is remdeE
Counry
Pl�J�
Township
ot aa"unant (last five
Drivers Gcense / Itlentifiratian / ONer numDar
of daima�rt's spouse (la9 fiva dq'AS)
-/ -U�' v/-V . V -�/ 0
�ry arry pprtion d ttre resdential sWCW te w Ihe land nW axreed4g orre (1) aae Nat imrtretliately
o� ihe WoPeM u6Eie0 b P�ur¢ inrnme.
Y /��t��2�a� /���s 30
�
Counry
T�,�,ro
I hereby certify ihe above statemenis are We, correU and complete.
Atltlress (rwmber a st2et, cily, state. and LP )
I�SO %�n�-�r.� r,✓�r,r.�/ v'; ✓.1 _ �r� n P
Land not e:ceeding 1
surrounding resldent
ONer land
Total land (line 1 plus
O�her improveme�
7otal improvemenb I �
Total value (!lne7 pl
1 hereby certiy the
and complet¢.
Veilying action - Sigriatl
Issu'vg State
Reco�d number Page
fown. townShiP) .
Is Ih periy'v� question:
�Real property � AnnuaOy assested rtwhile hdne (IC G7. i-
�s Nac struwre is used m pmCUCe ircome. Oesmbe Ure use and pwiiwi
� _ �
■i1/ //4 _ f �i_s i.a • ..,
� �
'ASSESSED VALUE� HOMESTEAD I �
UE I qT 100Y OF TTV VALUE
�
20 pay 20
NWwifASlarMirg eny
not assessed es reel P�PertY or to a menuleWrea nome ma� o�..� a.,,,=.,...... ""_ �"' ,
one�haH (72) W Ne assessed rdlue d Ne moD'de home a manufarlured frome.
Signawre ol Audllnr
i'
neC (monN. daY. Y��
auE (mm1h. tlaY. YEa�
. . I Date sgned (monfh. Oay,