HomeMy WebLinkAboutHomestead_Hyatt Jr"'" CLAIM FOR HOMESTEAD PROPERTY TAX
: ._,. � STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R72 / 6-09)
�a � PrescriEed by the Department af Loral Govemment Fnarice
....
INSTRUCTIONS: See reverse side for filirg ins(ructions.
��
fORM YEAR
HC10
FI�EI)
I(We) certiry that I(we) occupied as my (our) prindpal
place of residence or am are) buying the foll g described real property tor which a Homestead Property 7ax Standard QQ,dyuyc/ti�s hefe�daimed
under mnVacl on the date ihis app�lir.a,/Goryn filed, (date o7filing): p-� �
❑ I(We) ovm V�Am (are) buying under recorded wntract GIBSON COUNTY AUDITOR
❑ Am (are) entiUed [o occupy as a tenanFStockholder of a cooperative housing corporetion
� Have a benefictia� interest in Ihe Wst or the right to occupy the property under the tertns of a qualified personal residence Wst
daimanf
or r�aimam c�� rNe aig�a)
d'gifs) I Drivels ticense / IdenGfration / ONe
of daimanPS spouse (Ias1 five dg2cJ
tl buying on wntraa, Fce Simple avmels �ma
RemNels ofice wfiere mnirad is rew�tled
County � Township
Legal
,,� I ,�,�y.�,�
imber Issu4i9 State
�
Record wmCer Page
•
ict (city town. townshiP)
Is Ne yoperty'vi question:
'0�j'YDI��U(�"1J�'DaliS I LJ��wdae^v LIA^nua0yassessedmobilehome(ICbf.f-n
portim ot Iha 2saenlial swcWre w Ne WM not exceeding one (1) arte that immeEiatery surtounds ihat swcWre is used to produce incame, desmbe Ihe use and portion
O�Pen1' udTaed m poduce income. �� � '
'1-2t-10 (���.
Counry
I hereby certify the above statements are we, correa and complete.
Land note:ceeding 1
Otherland
y, slate, anA LPCOde)
� r Fi�S rJ 5T {�R,
. -
acre immediatety
irovemenis. ���
Tatal land (line 7 plus line 2)
Residential improvementv or Mnualty �Iling
Assessed Mobile I Manufactumd Hame Garege
Other improvements
Total improvemen6 (llne 0 Nmugh Ilne �
Total value (line J pl�a line n-
I hereby certify the above is true, cortect,
and complete.
VaifyiM) aUiOn - SigriaNlB Oflwtlitw
(3)
(4)
(5)
m
�8)
Sgnature of Assessar
Counry
natu af daimant
�
[
N ci-"7/„ � tl
20 _ pay 20 _ Lesser o( 60% of the assessed value of the homestead or 545,000
NofwiMSleritling any oiher provision, fhe sum o1 the tletluclions p2Ndetl in /C E7.1-12 to a mob�e Mme Nat is
rwt assessed as rael proparty w to a menu/uauied hmie Net B rot assassed es real properry maY ^ot erceed
ona-hall (1R) W Ne assessetl relue W Ne mobJe �ome o� manutactuied hwne.
sg�awre a a,a�mr
S
Tovnuhip
signed (rtronth. daY, Y��)
Date signetl (manN, day, yxa�