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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (111216-09)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions-
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CERTIFICATION STATEMENT
I (We)
--certify that I (we occupied?ass my (our) principal
place of residence or am (are) buying the following described rea mperly for which a Homestead Property Tax Ste ribpdusUdd sr+l ereby claimed
under contract on the date this application is filed, (date of filing):
GIBSON COUNTY AUDITOR
UD TOR
(We) own ❑ Am (are) buying under recorded contract
'g ��,,//
-
Ann
L7J� Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of t name)
O
Social Security d claimant (Last fie dials) Drivers li er se / dent Wl tion / Other number
Iswhg Sta
of claimant (last five
Name of daknant'
Social Security number of daimant's spouse (kst fiva digits) Drivers license / Identification IOher number
Issuing State
of claimant's spouse (Iasi rive digits)
CONTRACT RECORDED
If buying on coots, Fee Simple owners name
Recorders ot6ce where contract a recorded
Record number Page
PROPERTY DESCRIPTION
County
Township
ii— 'q (" ,
township)
U7
Parcal umber
L ' tton
Is the property in Question: '
1
'g
Real
property ❑ Annually assessed mobile tome (IC 61.1 -7)
If an of he residential or he ta not ex eedug one (1) acre hat immediakjy stlrmu ds that structure n used k produce income, describe he use and portion
of N party ubT¢ed k produce income. /� hl
ce Inco
a6- IV4- 101- 000.50 ao7
PROPERTY e BY-CLAIMANT IN OTHER COUNTIES
County Township County
Township
I hereby certify the above statements are true, coned and complete.
Signature of dahnant
Address (number and street dry, stale, and ZlPCOde) 6/0 �' `ru L��
�/ S7
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE
Land not exceeding 1 (one) acre immediately-
�.� -.'.`
",�T', -'.
surrounding residential im rovements.
,?;:� «".'- ,s,„
Otherland
()
50PRIR F
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements r Annually
Garage
(5)
_
fs'r1: T+ in n�5`aKk. fly,
Assessed Mobile /Manuct ured Home
ta
Other Improvements
(6)
v r
��;�- ;�; >z. *, ��
Total Improvements (fine 4 through line 6)
(7)
Total value (line 3 plea line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of Auditor
Data signed (monN, day, year)
STANDARD • r
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NoMitUtandiog any ofherprovision, the sum of the dodo Dons provided in IC 61.1 -12 0 a mobde home hat Ls
$
not assessed as real properly or to a manufactured hone that a not assessed as real property may not exceed
- - - --
orehaif (12) of the assessed velure of the mobile hone or manufactured hone.
Signature of Auditor
Date signed (mm N, day, year)
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