HomeMy WebLinkAboutHomestead_Hall"' CLAIM FOR HOMESTEAD PROPERTY TAX Fa� YEpR
_ STANDARD/SUPPLEMENTALDEDUCTION HC10
State Fortn 5473 (R73 / 12-09)
� y� � PrescriDaA by Na DepaAment of Locel Gwemment Finatce
I UCTIONS: See reverse side !or fiGrg insWctions. � � gJ � JL/
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1(We) certify that we my (our) prindpal
place af residence or am (are) buying ihe following described real property for which a Homestead Property Tax Standa, . 'on is hereby daimed
under contract on ihe date this application is filed, (date of filing). I(We):
❑ Am (are) buying under recorded conVect GIBSON COUNTY qUDITOR
Am (are) entllled to occupy as a tenent-stockholder of a cooperetive housing corpora[ion
❑ Have a beneficial interest in the Ws[ or the right to oxupy the property under tha tertns ot a qualified personal resitlence Wst •
❑ Am (are) the shareholder, partner or member of the entity ihat owns the property.
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Name W daimant (legal neme)
sooa� seauiH nm�oe. w dw�sm (�sr rne dyns� omers nre�e i menue� issu�n s�ca
or daimant (�ast frve digNs)
Name o! tla4nanCs sparse ( �me)
Soclal Securiry num6er of �faimanYs spouse (WSt (ne digds) Drivefs 6certse / Identlfiption / ONer numher IssW�g State
ot datrnanYS spouse (WSt five dlgitc)
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If buyitg m mniract Fae Simple owner5 name
Recarders oi6ce where contrarl is femrded Recad numbg Papa
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��n, TownshiP T�9 � (�Y ��D
..el number Leg�� tbn — Is e property in question:
rN al property � Mnualy euessetl mob0e home (IC &/.1-7)
If arry portion o/ tlu residentlal strucW re or 1he IarW not exmeding one (1) acre ihat immetliatety su ds Ihat stru Wre is used m pmduce incortie. tlewihe the use and portbn
U Ne p�operty uti�eE to protluce inewna.
a�-o �- z 6_ zo z�aSa ��a a
-.. . . : . .
Counry Township Cwmh T�P
I hereby certfy the above statements are we, mrrea and complete. sig`ature or unant
Address (number eM shael, dry, state. aM Z/POOde)
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1.and not esceeding 1(orre) acre ImmedWtey -. (�) Y'�u^�� �p� Y� ���� Y�
surtoundin resldantiallm roveme�rts.
S. i: i} s�-�.
Otharland (2) ,��r� �;�,��
Toml land (lirm 1 plus Ibre 2) (3)
� 4 c s�,� >�, ,y�r . `s`: �'�
ResidenUal fmprovemenfs orMnuafly �Iiln9 (4) # -;, �a* ���� ��`,,z-
Assesaed Mobile I Manufazwred Home G�9e (5� ��"-�� ��. ��. �:� t r'�` �:
r, �-�-K�...P`5€'s't- -
tc[ '.. %�J��
Otherlmprovements (C) ° t.+`�'-� '"�'
Total improveme� (Iine 1 tluough fine � (7)
I value (lirre ] pl/s Ilne 7) (8)
I hereby certify the abova Is We, eorreet, �9"a�+re of Asseswr Dale signed (rtrontn. deY. lea�
and eomplete. �
veifyv�p aawn - s�nanue d n„d�m� oam sip�a (monm. dar. r�l
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20 �� pay 20 �_ Lesser of 60% of the essessed value of ihe homestead or 535,000
Nofxithstandirg eny oNerprovision, Ne sum dNe deductiom Nowded'u� IC &7.7-12 to a nwW7e lame fhat is $
not assessetl as real pmpertya ro a manWacfured hortie Net is not assessed as mal property meY � exceed
one-nenli2l ame essessed rw„e wme monae r,w�e ormewtacrured ha,re.
�,,,� �� Date signed (month. CaY• Y'��
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