HomeMy WebLinkAboutHomestead_PegasusProperties LLC�•
"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ - STANDARD / SUPPLEMENTAL DEDUCTION
State Fo�m 5473 (R72 / 6-W)
�O � Preunbed by the Departrtrenl of Laol Government F�nce
INSTRUCTIONS: See raverse side for fil'ug
�` �`� FORM YEAR
� �
/� ( [/��} �
�Y — / / (/l1l�.A�1Y Y % ��0
'�"6� � v • at I( ied as my (our) prindpal
place of residence or am (are) buying the foliowin scribed real properry for which a Homestead P pe �f�+ a D uUion is hereby daimed
under conVacl on ihe date �his applintion is file4 (dafe of filing): U DITON
❑ ���,e) � )� 9 GIBSON COUNTY AU
❑ Am (are b n under remrded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperetive housing wrporation
� Have a beneficial interest in the Wst or the right to occupy the property under the tertns of a qualified personai residence irust
of daimant (legal neme)
` �
spousa
If buying on contract, Fae Simple mmers name
o1RCe where wnvacl is remrCeO
TwmSAip
ot tlaiman[ (last five dlgiLS)
omrers �icense �
of daima�rt's soo
� �
(
(rill: �own. town.VtiP)
Recard number
Page
�O �PO�'O 1�{ D-I � fl 8C J`�Dtion � • Is ��erty� tion: ❑ AnnuaOy asussed rtndle hane (IC 6f. f-
Ol
tt arry portim W the residential strucwra u Ne Wrid not ex�e0ing pre (7 ) aae Na[ immeAiateN surtountls Ihat svuctu`a is used m ptoduce irKw�e. dearnbe Ihe use aM pwtlon
01 Ne pmperty utS¢e0 to qoduce income.
• o P 33� .
Counry
Township
I hereby certiy the above ststements are We, correG and compiete.
Md (num6er artl alree4 �+N, s+ate, end ZlPcode)
I l l + r� n. vt
.• .
LanE not ezaeding 1(one) acre imm�^'-'-'�
aurtoundinp reslAential improvemei
Other lantl
Total land (line 1 plus line � ia ��D��,-
Residential Improvemenb or Mnuall�
Assessed Mobile / Manufactured Hwm ,
Other improvemertts �
Tofal Improvemenb (flne I Nrough line
Total value (flne J phs line �
1 hereby certify the above is We, �on
and wmplete.
Vailyi�g action - SigraW re of PLtlitor
Counry
20 _ pay 20 Lesser ol —
Nawim,vandeg enY �r piovision. Ne sum ��..,,w m iC 67.7-7Y ro e rmbne home Mat k I$
rrot essesse0 es real property w to e menuFarnnad home Net's not assessed as rcal properry may rmf exr�ed
orie�haM(1RJ Nlhe assessed vdlue W Ne mo6de hwne d mEnulactured home.
Toxnship
, I Date si9ned (rtronth. tlaY. Y��
Date
Eay,yea�