Homestead_ComerCLAIM FOR HOMESTEAD PROPERTY TAX jvo FORM
CREDIT /STANDARD DEDUCTION Hc10
State Form 5473 (R6 / 4-03)
Prescribed by the Depann ern of Local Government Fmarroe
YEAR �_
I (
residence the following described real property for which a Homestead PUUrolperty Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract
I Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pfoperty , is buying under a contract.
_ GIBSON COUNTY AUDITOR
NTRACTRECORDEDs' :s-
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
�-ee=. i[' !;•`ice•. ,x i
- iv"�a3 P,ROPERTY.DESCRIPT10N r�'i s' }�-' '' 'e -�-'` '`4a -4 '"3'31? cis '
County
Tovnship
Tadng district (city, town, township)
P r number
L escri Is a property in question:
-�� ❑ Real property ❑ Mobile Homo (I.C. 6. r'.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce inoome, describe the use and portion
of the property utilized to produce income.
_ ""s �`"'"-' ' t� 'eeyy++7�JJ .gyp' �PROP.ERTY,OVUNED;BY CL''AIMA ;IH'OTHER'COUNTIES,, aa�''&�-oi�, _0_
County
Tavnship
C my Township
I hereby certify the above statements are true, correct and complete.
ignature claimant
jre i fn aM s , city, slate, 2/P coda)
_ ( 1
�� cr
4ASSESSMUSE ONLY "":,;
`TR TAx 1,.,a
ASSESSED VALUE
+ >HOINESTEAD
1
N NESIOENTIAL
"' �>
3. .�+
z VALUE;
AT 100%4 OFTTV
ff VALUES'
¢. <.�,
x VALUE '}^
Land not exceeding 1 (one) acre immediately
(1)
- },.,�'yv
surrounding residential improvements.
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s •,s - �n'j,r
Other land
(2)
r' ENT,
Total land (line 1 plus line 2)
(3)
'Residential
Dwelling
(4)
Improvements or Annually21.,....wt=
s- _,.t�a.t.6.
Assessed Mobile / Manufactured Herne
Garage
(5)i
Other improvements
(6)
ti.a . #.. _ ?�-_ _ A
�,?--� t
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete. '
Verifying action - Signature of Auditor
Date signed
A-. �r'-. F; ST/ WDARUDEDUCTIOWALLOWANCE
20 _ Pay 20
Lesser of 1/2 Homestead
S
Vauanon or 535.000
Signature of Auditor
Date signed
D -ad -o,S-
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