Homestead_Thomas (18)�
" CLAIM FOR HOMESTEAD PROPERTY TAX
rt � STANDARD/SUPPLEMENTALDEDUCTION
S ^ �_ $f�te Form 5473 (R12 / 6-09)
�O � � �'resaibed by Ne DeOanment ol Laal Gwemment F�aixa
•VSTRUCTIONS: See reverse side !or filing insbuclions.
FORM
HC70
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�J
YEAR
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nv �
i(We) certify Nat I(vre) occupied as my (our) primipal
place of residence or am (are) buying e o wing described real propeAy tor which a Homestead Pmperty Tax Standard Dgydu�c/Gon is t��Dy daimed
under mntract on ihe date �his appliraG is filed, (dafe o/fili�): p�� �h F3 ���'
C/ ��
❑ I(We) ovm ❑ Am (are) 6uying under remrded conVact GIBSON COUNTY AUDITOR
❑ Am (are) enlitled [o occupy as a[enanFStockholder of a cooperative housing corporetion
� Have a benefidal interest in lhe Wst or [he right to occupy the property under the terms af a qualified personal residence Wst
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Name of da'unant (legal name) '}�^
V„ �
Sodal Smmty of tlavnant (m5 fie E,g3s Orivets license I Itlentifratbn /
Sadal Secunry number of daimant's spouse (W9 frve tlig'RS) Drivers Pcense / IdenGfraiion / Oiher number Issuing State
of da"unanPS spouse (last frve digrts)
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If buying om m�Yacc, Fce Simple ownefs name
Remidefs office where mniraa is rewNed Record number Page
..�. . � . �
���y Township Tarirg dk � , M , township)
PamxJ number Legal tl¢.aiption Is Ne p rty in queslion:
a6� .�� I property ❑ MnuaOy assessetl rtmbile home (IC G7. f-7)
tt any ponim of Ne residential swcwre w �he W�W not exreedirg arre (1) arre Ihat immetliatety wrtounds Ihat strucNre is usetl m p�oduce i�ne, descri0e ihe use aM portion
of ihe p�operry utd¢ed to produce income.
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Counry Tovmsttip Caunry Townslup
I hereby certify ihe above sta[ements are We, correU and complete. �9 ot daimam �
dress numberantlsheef,ary,state,arMLPcode) �
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Land not exceeding 1(one) acre immediauly (�� ��i' �, �,�. z�..������*�',i,
sunoundin residmtlal im rovements. '�+'+?��> �_•
2 "�=� "�7`}!':'�,',�.
Other land ( ) �; �:,.�.��,.�:.y��y
7otal land (line 1 plus line � (3)
Dweiling (4) {� G�f'.�.'� 'A S�'i�i{L� � '33�ii°: t✓rt
Residentlal improvemenfs or Mnualty -
Ossessed Mobile I Manufactumd Home Gara e �; ���� fY�" y�����
9 (5) �--"s� x �.0:��'r+ K�r
s Y^K ..rv. . :�'v
Other improvements (6) 2�' '4 � i�`��I�`n"=
7ofal improvements (line e Mrough line � (7)
Tota1 value Qine 7 pl�s line 7) (8)
1 hereby certify the above is Irue, cortect, Sigrewre otASSessar Dare sgned (mmN, day, yea�
and complete.
VaiA'Mn9 action - Signabne o(lwditur Da:e signed (mmth. CaY. year)
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20 _ pay 20 Lesser of 60% of the assessed value of ihe homeslead or.S45.000
NMWASIaMing any olhei provision. Ihe wm o( Ihe detlurliorss provided in IC 61.1-12 fa a rtpWle fqme Nat ic g
mf essessed es raal propeNy w to a manulaUUred home fhat is nof essessed as raal properry maY �f erceed .
one-hatl ) W Me asussetl ralue W the rtnbYe hortre wmanutarturetl fron�e. (p�qn1h
of irar Date � (/ �y� /� .
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