Homestead_BryantCLAIM *:FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
V State Form 5473 (11614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM YEAR
HC10
A °i�,,.�CEFMFICATION-STATEMENT�;,,
certi de
:(,Z),occillpied ou tcipefillpt o residence the following descril0d real property for which a HomesteaTfaLcredfrerned.
Fj I (We) owned ❑ Are buying under contract
9iave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propertun bVw 2na contract.
v,�";t," *,:,CONTRACTRECORDED*�,
If buying on contract, Fee Simple cromer's name
GIBSON COUNTY AUDITOR
Recorder's office where contract is recorded Record number Page
';Akffiu 4 ;r;'7k-_Z-0W A P!46PERTY IYES C RI KTI ON'*9 "A t4 4
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County
County
Township
I hereby certify the above statements are true, correct and complete.
I Taxing district (ch)• to", township)
m6e
rir
VALUE .4,
Land not exceeding 1 (one) acre immediately
a property in question:
Xn
-00
g
q1j
surrounding residential Improvements.
❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (i) am that immediately
sumcxmds that structure is used to produce income, describe the use and portion
of the property udized to produce income.
Otheriand
�PR4jOE�Otl;Y.'dWNt6,.BYCL•AIMANTiiN'OTHEWbOUtJTIESgX
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County
Tmmshild
County Township
I hereby certify the above statements are true, correct and complete.
Si I fcI I
NI L
(number and street, city, state, ZIP code) Cv I I t
ASSESSOR USE�ONLY
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ASSESSEDNALUE
P
1.4—'HOMESTEAD4,
Lesser of 1/2 Homestead
100% OF4T.TV
rir
VALUE .4,
Land not exceeding 1 (one) acre immediately
Signature of Auditor
Date signer/0_0 ,
surrounding residential Improvements.
Otheriand
(2)
X
Total land (line I plus line 2)
(3)
Residential improvements or Annually
Dwellin g
( 4)
Assessed Mobile I Manufactured Home
Garage
(5)
improvements
(6)
,O1bel
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or 535,000
S
Signature of Auditor
Date signer/0_0 ,
W