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Homestead_Wright (4)�..,
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R13 / 72-09)
PracrsiMM M thw Mrurtmnnt nt 1 mal C,rnrmnmant finam»
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INSIRUCTIONS: See �everse slde lor fitirg ins6uctions.
I(We) • ceAiry that I(we) ocpu� ap!gy�prindpal
place ot res' nce a am (are) buying the fdlowing described real property for whi Homestead Property Tax Shandard DU ucdon� is hereby daimed
� er on ihe date ihis applicatio� is filed, (date o�filing). I(We): C.'J.M �—�-.-y
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❑ Am (are) buying under recordetl contrect V V
❑ Am (are) entllled to occupy as a tenant-stockholder of a cooperelive housing corporatlon GIBSON COUNTY AUDITOR
❑ Have a benefidal interest in the Wst or the rignt to ocwpy the property under the tertns o( a quaiified personal residence Wst .
❑ Am (are) the shareholder, partner or member of the entlty �hat owns ihe property.
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o( da4nant (kgal narta)
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Sorial Seariry numher of tlalmanCs spouse (/ast five d'g/ts) Orivefs Ocertae I IdrntiOption I 01her number IssWng State
of tlaimanYs spausa (lest (rve digds)
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If buying on convact, Fee Simple avners rame
Remrders otfice where ConUaG is 2corded Retord rwm6er Page
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County TawnshiP Tav�g di,trid (dty. town� townshiD)
I num q� Legal desaiption Is the propery in puestion:
� ' 3 �V � • ao _O ❑ Real propeny ❑ Mnuairy essessed mohile homa (IC bf.7-7)
It arry portirn ol the residenUal sWCture or ihe IarW nol exceedinp ona (1) aue that irrimed"ute�y surtounda ihat strudure is used W Produce ircome. deuribe Ue usa aM portion
W tlie property utilkad N protlum Inmma.
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... . . _ . .
Coung' Tovmship County Township
I hereby certify Ne ebove statements are We, correct and complete. signa f da'unant
AdEress (number e� sheef, rify, state, erM;lP toda) y� `
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Land not exceeding 1(orre) aere Immedlatety (�� '� F y`��'�"'�'`„x„t.� �""�t '.
surroundin realdentiallm rovements. �—g'x- �'.= �flY x
"�i h«: d.8�
'�`Frvr,'.:, r. �_ �a:+,
Other land �2� :J, c-�.? �f:'?�.2'%P=
Tomi iana prrre , pms mre T �3�
h:'�- i� , =2 �F`-� ``� �
ResiderrtiallmprovementsorMnualy ����ng (4) �„� ,;y"�x.� �,,,y-,-r�,-q.;r
Assesud Mobtle I Manufacwred Home r� ��`F �. yi��; €js jF�^- �.
Garage ($) ._�-�=�.__•�`,._..,._..._:t:k.,_iF..�7�.� �..:x
1 f�r-`� i?a.'3"'�_ .
Other Improvemenffi (C) # � ef $�" yy3es"`b;«
Total improvements (Ilne I Nrough line � (7)
Total value (line 7 p!(a Iine 7) (8)
1 hereby eerd/y the above is We, correct, �"a�re of ��Of �� �9�d (�th, dey yea�
and wmplete.
Vaify"ug action - Siryaeire of Autlitv � s9^� (^b^N. �Y• Y�A
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20 pay 20 _ Lesser of 60% of the essessed value ot the homestead or $45,000
NoMilhstending anyWherprovision, (he s+im of Ne deductrons provkietl in IC 61.1-f2 ro a rtrobBe home Nat is �
not essessed as'eel property w ro e menufactured home Nef is no( essessetl as rea/ proparty maY raf exceed
one-Aatl (f2J ol Ne assessed ralue ol the mo6ile fartre ormenufectured home.
SgnaLUe of Ndimr Date syned (month, tley, yeaQ
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