HomeMy WebLinkAboutHomestead_WhitfieldCLAIM FOR HOMESTEAD PROPERTY TAX
_ � STANDARD/SUPPLEMENTALDEDUCTION
- " State Fortn 5073 (R73 / 12-09)
� f P25tnDatl by Ne DepaNnant of Local Govemment Finaxe
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INS7RUCTIONS: See reverse sJde /or fiGng ins6uctions.
FORM YEAR
HC10 �
l
I(We) certify that I(wej�.{�pl�d��ihhl(nur) prindpal
place of residence w am (are) buying the fWiowing de 'bed real properry for which a Homestead PropeRy Tax Sfandard Qeduch�by daimed
�nVact on the date this applintion is filed, (date o/filing). I(We): C �
Own ❑ Am (are) buyiry under recorded conVect GIBSON COUNTY AUDITOR
� Am (are) enti�ed ro occupy as a tenant-stockholder of a cooperefive housing corporatlon
❑ Have a benefidal interest in the wst or the right to ocwpy the properry under the tertns of e qualified personal residence Wst •
❑ Am (are) the shareholder, partner or member oi the entity that owns the property.
E!!; �r
Nama
t . �
o! daimant :fest fie d'
spouse pasr rNe myra) ori�rs oanse i iae„uruxw� i ane
or da�manrs spouse pasr rrve cgns)
If buying on contraU. Fee Simple owners �me
vihere contraC's tecorded
Counry
d'strir� (tifY• rown. loWnship)
Issuing
rnunber �Page
ia ob ya3•oo3���i� � ag� �,=�e ,��' o,����a��,��,.,_n
If airy portion of the resdential sWcture w 1he larid not exceeding one (t ) acre that immediately su�unds that sWtlure is used to p'oduce irwort�e, tlesaihe the use and pMion
d Uie poperty u0�ed m produoa Nmne.
� �Ja�.oc,h,a Q.�.� 31 �'
-.� . . _ . .
Counry 7ownship Cwnry TavnsNP
I hereby ceAify the above sfalements are We, correcl and compiete. S re �d�i nq' �i ,�. n/�
Land not esceeding 1(orre) acre immedlatey
surtound)ng resldenUal improvements. �»
Other land (2)
Tatel land (Ilrre 1 p/us lilre 2)
ResitlenUal Improvemen� or Annuaity
Assessed MobOe I Manufaetured Home
Other Improvemenffi
Dwelling
Garage
Total improwmeMS (llrre 1 through line 6)
Total value (llne 3 plus Itne �
I hereby eertiy the above Is true, correct,
and eomplete.
Verirying acUal - S'gnaLlre of M1ditOr
(3)
�4)
(5)
(6)
�)
(8)
_ pay 20 _ Lesser of 60Yo of the essessed ralue of ihe homestead or $45,000
NohvrMSfeMing anyWher provision, tha 5um of Ne tletluctbns prowtletl in IC Gt. f-12 to e mobile homa Mat is
nof essessed as real property w fo e menWectwed home Nat is not essessetl as real properry may rat exceetl
one-71eHlf/O o1 Ure essessed �lue of the mobde M1ome w menWachned home.
$
Date
Date signed (monN. Cay,
Signa4ire of NWitw Date sign (month, day,
%� T I���w.�w w..�.. n. . � � �%�
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