Homestead_Richardson (12)CLAIM FOR HOMESTEAD PROPERTY TAX
t STANDARD/SUPPLEMENTAL DEDUCTION
Siafe Fartn 5473 (R13I 12-09)
� ! PresaiEed G/ Ure Departrnent of Lacai Govemment Financa
FORM Y�
HC10
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INSTRUCTIONS: See raverse side (o� filing inshuctions. g i�
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I(We) certify Ihat (w"""e)"�-o"""c���ar�p-ie�d as my (our) prindpal
place ot residence or am re) buyirg ihe fdlowing described real property tw which a Homestead Property Tax SL,anasra�6�s hereby daimed
�ier mntrad on ihe date this application is filed, (date o/filirg). I(VJe): v v
Own ❑ Am (are) buying under recorded contract GIBSON COUNTY AUDITOR
� Am (are) entltled to occupy as a[enent-stockholder of a cooperalive housing corporation
❑ Have a bene5dal interest in Ne trust or the right to ocwpy Ne property under the tertns of a qualified personal residence Wsl .
❑ Am (are) ihe shareholder, partner or member of Ne entiry that owns the property.
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Name of dal )
so�s�aN,�a ' t��> o(asr���i0asr�re�c;¢� ��"unsm'� 'T"N
Name w ds�ma�rs saase (kga� name)
Social Seniriry number ot da'vnanYs spouse (last (rve dgVS) Orive/s 6rcnse / Itlentification / Other numbar IssWrg 9ate
or dahnanrs spouse (�asr rrve d.gilsJ
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If buying on cantract, Fee Simple owners rame
Recarder's office where contraC is recnrded Remd numbcr Page
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County Township Taring distrid (ciry.
P number ��� �P�n Islh inquestion:
_ g-3bl-O .17o-oa8 �� ❑�,�����a�u�b,.,-n
If Pwtion of Ma rasidential sWcture w the Wnd not exceeding ane (1) acre Nat immediateN s��rrwnds ihat struCUre is used W Produce'vwome, Cesaibe the use and patim
of Ne property utiliud to p�oduce inmme.
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Counry Tovmship Counry iownship .
n n
I hereby certity Ne above statements are We, correct and complete. Signatu nt �
,��,���,a,w��iF��� /-�YE sa�i/UC.�>v�t1 �i!/� . 7 �
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Land not exceeding 1(orre) acre immedlataty ��) +�:: �>��,{�'• �.��,�'-? �,,g�,
surroundin rasidentlal im rovements.
f 4 -�{�3�_.-v
Othar land (2) � . .r�_r 3+�_.
7om1 land (line 1 plus Il+re 2) (3)
Reside�al improvements or Mnualty �Iling (4) °�`'���a -��:y����,`�.�q��
Assesaed MohOe I AAanWxtured Home g „F.'�" Z x sS�'x"� '� `+'��g,�FS y-=
Gera e (5) ,,t ..�:<i�..-,._..? ��...b..-.
Other improvemenb (6) ���-;��YF ���'
Total improvemerhs (line / through line � (7)
Toml value (line 3 pl`a Iine � (8)
I hereby certify the above is We, correct, �"a�� of ��Of Date signed (month, day, yea�
and wmplete.
Veifyug acUon - SignaWre oflwtlitor � y9� (�^N• �Y• Y��)
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20 _ pay 20 _ Lesser of 60% of the assessed value ot Ihe homestead or $45,000
Mo(wiMSfending any oNerpiovisron, fhe wm o! the detlucfions provNed in IC 61.7-12 fo e moW7e fame fhat is $
not assessed es reel propeM a ro e manulactured frortie Nat is not assessed as real propaAy mey rot exceed
rn f21 o W Me rtabde home armamdactured honre.
�� D�ate sigpep (rtq�t�� /ar)
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