HomeMy WebLinkAboutHomestead_Barrett (8)CLAIM FOR HOMESTEAD PROPERTY TAX
_- STANDARD/SUPPLEMENTALDEDUCTION
' State Fortn 5473 (R73 / 72-09)
�„w P�escnbed by �ha Departmenl of Local Gwemmem Finanm
INSTRUCTIONS: See raverse sfde /o� fiG/g insWdions.
FORM
HC10
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�(yye) certity that I( pi as r) ri
place of iden w am (are) buying the tollowing described real properry fw which a Homestead Property Tax Shan ard i d' ed
urWer mntracl on ihe date this application is filed, (date of filing). I(We):
gOwn ❑ Am (are) buying under recorded conVaG NOV 1 3 2012
❑ Am (are) entllled to occupy as a tenant-stockholder of a cooperetive housing corporation C,�_
❑ Have a 6enefidal interest in Me trust or the right to ocwpy ihe property under Ne tertns of e qualified personal residence Wsl
❑ Am (are) the shareho�der, partner or member of the entlty that owns the property. GIBSON COUNTY
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Name of t (legal nertre� , /�
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so� h
Sodal Sec�riry numher of UaunanYs spouse (fast frvz diglls) Orivefs licensa / Identifintbn / 01her number IssWng Sate
of daonent's spouse (last frve dlgifs)
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It buying on tomrect, Fee Simple ownets nama
Recorders ot6ce w,ere mmrsa ts recordea Recard number Pape
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Counry Tovmship Ta�dn9 distrKi (rill: !o , townshiP)
Patcel number Legal tlesaiptlon , s�( 1%�� Is �he perty In 9uestion:
� � PReal popeny ❑ AnmwOy essesseA mob0e Iwrtre (IC G/.7-7�
If arry portion o1 the residentlal struclure or Ihe IarW nol exceeding one (1) acre that immedately wrtountls ihal swclure is used m pioduce incoma, tlewibe the use aM portion
d Ne poperty uUl�ed to protluce Inoome.
,�l0-14-19-aaa-oo/. �1-l-Da(e
•.• . .: . .
Counry Township Counh Ta.mstdp .
I hereby certify ihe ebove statements are We, cortect and complete. Sig�awre of 'unant
: � �
Adtlrtss (numbar ard street �xN, state, aM ZIP cada �
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Land not exeeeding t (o�re) aere Immediatey (�� � ;�'� �t`'� -K�" "��_ ._ � �;
surtoundln realdentlal lm rovements. �;:�! -
Other lantl --'�4 ~':�` ��Y�
�Z) '•r'+`': i�,..:..'S.;',.
Total land (line 1 plus ILre � (3)
Dwalling (4) +.r�'?� ��° �s�i��i�'-
ResideMlal fmprovements or Annuaity � -_ -„_
Assessed Mohile I ManuFac4ired Hortre Garage (5) �,�x-� ���'�`i g rx�`��fc�?;'�.
+a-: rs�
iiCiKy:i -_�.t„����, .
ONer Improvemenb (6) x�;:.,_,� 3'�.^�s�:.'.'�
Total improvemeMS (Ilne I Nrough line � (7)
7ota1 value (line 3 pl's Ilne � (8)
I hereby certlfy the above is We, correct, �9^a�+re oi Assessor �ete si8� (�^�• �Y. Y�A
and complete.
Verifying eciion - Signature of /wditnr �� s9� (�^N, �Y. Y�A
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20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
NaMiMSfand6g any oNerpovisiar. Ne wm d Me de0uctiorts provHeE � IC G/.7-12 ro e rrpbile home Maf 'a $
rrot essassed es reel property a to e menWaGUred hana Nat k not essessed es real propeM meY raf exceed
one-fiall (f21 W Ma essessad ralue olMe moWe home or manWecmred homa.
Signature at /udila Date signed (month. deY• Y88�1
C �T_
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