HomeMy WebLinkAboutHomestead_HaydenCLAIM FOR HOMESTEAD PROPERTY TAX
�__ STANDARD/SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R73 / 12-09)
� � PrescriDed by Ne Department of �ocal Gwemment Finaue
WSTRUCT(ONS: See ieverse slde /a� filiig instrucGOns.
FORM
HC10
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� (yyej Ad,1J certiry ihat1Lwe) �u��o�
place of resldence or am (are) buying the f owing described real property fw which a Homestead Property Tax Sfandard Deduclion is here y da
��ae� �o�rraa a, me aate mis aPPrcauon is e�ea, (aara orfil;�9>. �(we�: NOV 2 6 2012
�Own ❑ Am (are) buying under recorded contrect
� Am (are) enti0ed to occupy as a tenant-stockholder of a cooperalive housing wrporadon C���
❑ Have a 6enefidal interest in Me Wst or the right to ocwpy the property under the tertns of a quelified personal residencen�trus "•
❑ Am (are) the shareholder, partner or member of the entity lhat owns ihe property. GIBSON COUNTY AUDITOR
�i1.r`�'i '2 i.-«��yF:=F '�!!?�..�XSC.�-,1...�ti�t-..�w: �ir+�7.�N;;�.z-;r.P.ROP.ERT:Y,[
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Counry
Tow�nship
I hereby certfy ihe above statements are We, correct and complete.
(number entl sbeef, d(y, state, ard LPmCe)
Land not excoeding 1
Other land
acre Immedlatey I i�)
m� �
Total land (Iine 1 plus llrre 2)
ResidentiallmprovementsorMnualy �����9
Asseased Mohtle I Manufaetured Home ��9e
ONer Improwments
Totel improvemaMS (Ilna I through line �
romi �mue u��a s pna nrre n
1 hereby eertiy the above is true, corteet,
and complete.
Veify'v�g action - SignaLne Mlwtlitur
(3)
(4)
(5)
(6)
(8)
townshiP)
�i a�aem L
11 U18S SVIlCNR R USCE �O
s
l
20 _ pay 20 _ Lesser of 60% of the essessed value of ihe homestead or $45,000
Nonvilhstantlfng any oMerpmvis'on, Ihe sumW fhe deduabns providad in �C 67.7-12 ro e rmW7e home fhat is $
nof essessetl es real propeM d ro e menWawued noma Nat is rat essessed es reel property may na erceed
orre-had (f210! Me assessed vehre olUre moW7e home w manWactured home.
SgnaW2 otlWditor
Remrd number
Peqe
an�uaoy essessea moboe nome (re s�.�-
�duce income, tlesaibe ihe use aM portion
Trn++ishiv
(montn, eer. year)
(monfh, daY• Y'��
Date signed (monfh. daY� Yea�
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