Homestead_DicusCLAIM FOR HOMESTEAD PROPERTY TAX
. __ STANDARD / SUPPLEMENTAL DEDUCTION
' State Fortn 5473 (R13 / 72-09)
� Presaibed by Iha DepanmaM of Local Gwemment Finance
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INSTRUCTIONS: See reverse slde fo� filing instructions.
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FORM
HC10
t(We) TiYnAL�� S\ ti, f�,�Ja- ceniry� � e) pi�s r
place of residence w am (are) buyirg the follovring described real property fw which a Homestead Property S �e�i u
urWer contraG on Ihe date this application is filed, (date o(filing). I(We):
❑ o,m ❑ Am (are) buying under recorded contrsct NOV 15 2012
� Am (are) entilled ro occupy as a tenan4stockholder of a coopew6ve housing corporation C_�, n�
❑ Have a benefidai interest in Me wst or the right to occupy ihe property under ihe terms of e qualified personal residen
❑ Am (are) the shareholder, partner or member of the entity that owns lhe properry. GIBSON COUNTY AU[
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ea��y��ry I] ^ Legal esr+ipilon �] Is Ne propeny in Question:
l�^ t U �✓^�OJ � O •� O l^ O C.� � ❑ Real property � Mnually essessed mohile tame (IC 61.7-
If arry portion of the residentlal sWCture or Ne IarM not exceedin8 ona (1) acre Nat immediatey wrtounds that sWdura ¢ used ro p'oduce incane, tlewibe Ue use aM portion
W the poperty utilized to protluce Intama.
Counry
Townsttip
I hereby certiy ihe above statements are We, correct and complete.
Addrass (numbe� eM sbeet, dry, stete, aM ZIP coda)
Land not eaeeeding 1(o�re) acra Immediately
Other lantl
Tofal land (line t plus lirre 2)
ResideMial improvements or Mnualty �����9
Asseased Mobile I Manufacwred Homa �9e
Other improvemenb
Total ImprovameMS (Ilna I fhrough line 6j
Toml value (Ilne ] plla Ilne n
I hereby eertity the above is We, cortect,
and wmplete.
Veifyug attbn - SignaGire oTlwtlitur
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(2)
(4)
(5)
(B)
SlgnaLUe of Assessor
20 _ pay 20 _ Lesser of 60% of the assessed value of ihe homestead or $45,000
NoMi7M1SIeMIng any otherprovision, fhe sum o)Ne deducfions povided in IC 67.7-12 b a mobile home Ihat is $
rpt essessed es real yoperry w fo e manNacfured home Mat is no( essessad as real property may not esceed
one-4aHl721 W Ne essessed veNe d the mo6de Mme w manWxtured lame. ..
SiBtature
Township
Date siBneA
Dam sigfred (rronN.
Date
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