Homestead_Stilwell (5)CLAIM FOR HOMESTEAD PROPERTY TAX 1� P�
STANDARD/SUPPLEMENTALDEDUCTION
Stata Fam 5473 (R13 / 12-09) `jl �) � Cyr`�.
0 , Presaibed by the Depanment ot Locei Govemmem Fi�nce
INSTRUCTIONS: See ieverse slde (or fiGng insbuGbns.
FORM
HC10
YEAR
1(We) 1 certi(y that 1(we1 oCW WEY I�Sl"t�(�[Q rt����
placa o res'�dence or am (are) buying.ihe foll ing described real property fw whirh a Homestead PropeAy Tax Standard Deductionr,�i�s-h�2ere—by daimed
�er d on ihe date this application is filed, (date of filing). I(We): C��� �
❑ Am (are) buying under recorded conUect
❑ Am (are) entitled to occupy as a tenent-stockholder of a woperative housing corporatlon GIBSON COUNTY AUDITOR
❑ Have a benefidal interest in Ne Wst or ihe right to ocwpy the property under ihe tertns of e qualified personal residence trust .
❑ Am (are) the shareholder, partner or member of the entlty that owns the property.
E?^�ll
�
Foaise
�t'•�i°.'�+`-_"�>`.^.Y#.� � .:.-,52��!.Fa.6`r` .a�-..t4�ti`
_' . �
Legal
of tlaimant (Iasi fiw digiGC) �
Drivefs 6cense / Identlflratbn / Olher
of daimanYs spause (last five digils) /�
distriU (tity, town, townshiP)
4s the property in queslion:
�ssuins
RemrC
Pape
�cb-I�-Db-yod-o�y �aK-oa� I LJ��ww�r L._1����r�e�uan�ucb�.�-n
It arry ponian W the residenlial structure or Ne I�d not exceeding one (1) aae that immetliatey surtourMS that StruUU2's used to produce inmme. C�cnbe the use and pafim
a w�e�ry ueraea m aoe�m i�co�.
�� �(1 � I� i/� 3 8
Counry
I hereby certify the above statements are true, correG and mmplete.
(number eM streel, city, state, aM ZIP oode)
/n7l 13 �✓%�CF{-IA/'o0
Land
Other land
acre ImmedWtey I ���
m�eme�k
Total land (Iirre 1 plu9 Ilne 1)
Residentlal improvements or Annuafty �����8
Asseased Mohle I Manufactured Home . Gara9e
Other improvements
Total improvemeMS (llrre 1 throug� line �
Total value (line 3 plts line �
I hereby certify the above Is We, correct,
and complete.
�aiyirg a�Ybn - SignaNre oflwtlitw
�2)
(3)
(4)
(5)
(6)
�)
County
20 _ pay 20 _ Lesser of 60% ot the assessed value of ihe homestead or $45,000
NoMilhstanding eny alherpovision, the sum o/ Ne deducfbns providetl in IC 61.1-f 2 ro a mob�7e hort�e fhat is
nof essessad as real piopeily ar ro e menufaUUred home Nat is nof essessed as reel pioperty may mf exceed
one.hall /121 al fhe assested vel�e ol the rtrobde fama o/ menufeCUred home.
�
S
7o�msNp
i �0 7 CJ
Dam sg�tl
Y�A
yea�