Homestead_Bailey (8)CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTAL DEDUCTION
- ` State Fortn 5473 (R73/ 12-09)
t y� presmLed by tha Deparlment af Local Gwemment Finarxe
�
FORM
HC10
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INSTRUCTIONS: See reverse sfde )or filing insWeUons. ��i �C.6 / �v"""'° � �z % � � �
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� (We) �N ( Y nave�
place of residence a m(a buying the following scribed real property for which a Homestead Property Tax Sfandard Deducfion is hereby daimed
under contrect on ih date ihis application is filed, (date of filing). I(We): O C T 1 10 � 2
� Own ❑ Am (are) buying under recorded mntrect C,�
� Am (are) entliled to occupy es a tenent-stockholder of a woperative housing corporation C
❑ Have a 6enefidal interest in Me Wsl or the right to ocwpy Ne property under the tertns of a quaiified personal residence tru'St
❑ Am (ere) the shareholder, partner or member of the entiry that owns ihe property. GIBSON COUNTY AUDITOR
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rlame aaimam (kgal n
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Sodal Seauiry ot (bst fi�e dgds) Drivers Gcense /
Soda1 Seariry number ot clau�anYS spouse (WSt fire d'glls) Drivefs Gcensa ! Identifintion / Other rwmber IssWng Sfate
ot daunanYs spou�e (lastlrve dgds)
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If buying on conlydct, Fee Simple owners reme
Reco�defs ofiice wt�ere con4aC is recorded ReCON numEer Pepe
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County Tovmship Taring ..(�, Mwn� MwnshiP)
Pa�ceJ numbar Legal tlesuiption Is the yoperty in Queston:
.S.S .3 y� ❑ Rea� property � annuaoy essessea mob0e rrome (�c sf. f-�
It any portion of the residential sWqure or the IaM rat exceeding one (1) a�re Nat immediatey wrtwntls Nat swaure is used to produce income, Eescribe the use ard pation
of the property u611zatl m pradufa inooma.
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County Township Counry Tamship
I hereby cer6fy the above statements are W e, correct and complete. Sig oi rtpimant
✓ �(numear dry, sta . aM ZIP �n � ` /' �/ � �_ �O� T, � /
/� c�f� ..lJ%�� �p
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Land not e:ceeding 1(orre) aere Immediatety ' � �s�,�;� .*'j„� 3���y o-'� �� �`� �-
surtoundln realAentiaf im rovemeMS. � � .-c _ . z :� "s �
°'�`=::it"1� ,Y� �
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Other lantl (2) � F;g._ �'���c";t�._
Total land (line 1 plus llrre 1) (3)
� �_r � : .._ ..
ResideMial Improvemen[s or Mnually �IIIn9 (4) =, :r'`•rk'� k ����..;,�,y.��
Asaessed Mobiie I Manufa�tuted Home Caare e i�° F•'�� �s.>...� °,rS �.r�-,.T;
_
g .+±x: �.. ...�..... __. _ : z_�'?�-_: ` ; . -�.-..-.
J".:.a�g �'>'�;r:,t`1'�3,
Other Improvements (6) ,.'es.;;,'��+.;t?; �:aFpJ�;"=._
Total imp'ovemaMS �llne 1 Nrough line 6) (7)
7ota1 valua (lirre 3 plla Itne 7) (8)
I hereby certify the abova Is true, correct, �9^a�re of Pssessor Data si8ned (monfh, day, yea�
and eomplete.
vesrw�e aaw„ - s�amre m a,a��« oam sqnea (monm, der. r�A
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20 _ pay 20 Lesser of 60% of the essessed velue of Ne homestead or $45,000 �
f�bfxifhstend6g any oNerprovision, fhe sum of the aeducibrrs provitled in IC 61. f-12 ro e mobde home Mal is $
nof assessed es mal property w to e menNaCUred home Nat is no( esse5sed az 2el property may no! erceed
me-hatl 721 W Ure assassed vehreW Ne moW7e hmia w manWect�red hame.
Signature o�i Date signed (�th. day, yea�
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