Homestead_BroganCLAIM FOR HOMESTEAD PROPERTY TAX
__ STANDARD / SUPPLEMENTAL DEDUCTION
. . State Fortn 5473 (R73 / 72-09)
t yw � PrescriEed by Ne DepaAment ot Loral Gwemment Finaxe
INSTRUCTIONS: See 2verse sfde for fiGng insWCtions.
FORM
HC10
YEAR
I(We) � certify ihat I(w��pi�my (our) prindpal
place of residence w am (are) buying the foilo ng described real pr rty for whirh a Homestead Properry Tax St�iid edu s hereby daimed
under contraG on ihe date ihis application is filed, (date ol filing). I(We):
c.�.m \' V
❑ Own ❑ Am (are) buying under recorded conVaM
❑ Am (are) entilled to occupy as a tenent-stockholder of a cooperotive housing corporation GIBSON COUNTY AUDiTOR
❑ Have a benefidal interest in Ne Wst or lhe right to occupy the property under Ne tertns of e qualified personal residence Wsi .
❑ Am (are) the shareholder, partner or member of Ne entity that owns ihe property.
�vanbr� � � � � �)
6p0U98
If buyirig m contraU, Fee Simple wmers name
of daimant (lasf (rve digiGSJ
Orivers Ikensa / Idendfication I ONer number
ot tla4nanYS spouu (last live d(g'rts)
• � •
_
:�i`•A.�.sk� r}'�yJ�i��... v:�r y Y,�.y -•,.:tx;.'j
- ' �
distriG (city,
�"' I������ I� I W� � Is Ne prop¢rty� �❑ Annually essessed rtn6Je home (IC G1. f-7)
�{ OC Viea
If arry portion af Uia residential struclure or the IarM not exceeding one (1) afre Nat immeEiatey surtounds that sWCNre ¢ used tn pmduce income, Oewibe ihe use and por6on
of the pmperty utllized m proCwn Income.
-�• • �: � �
Caunry Township Caunry Tamship
i hereby certiry the above statements are we, correct and complete. signewre or daimanc
(' ! ,
(numDer entl sbee4 �'rtY uate. eM ZlPCOde)
land not azceeding 1(orre) acre immedlatety
Otherland
Totel land (lirre 1 plus Itne T)
Residerttlal improvemenfs or
e�:a__ Mobile I ManufacNi
ONer improvementa
o pRIE
(�)
�2)
(3)
Dwellin9 (4)
Garega (5)
Total improvemeMS (lirre / through line 6j
Total value (Ilne � pl�s ILre 7)
I hereby ceNfy the above is We, correct,
and complete.
Jeityug aCbn - SignaWre otfWtlimr
(g)
Signawm ot Assessor
57: OA/',iA
20 pay 20 Lesser of 60% of the essessed value oi the homestead or $45,00�
NoMiMStending any afherprovi&on, (he sum o/ fhe deductions provided in IC 61.1-12 fo B mobile honre fhef is 5
nof assessed es rael property a to e menWactured home Nat is not assessed as reel property may nof exceetl
one�hntll721 W Ure essassed �aNa ol fhe moWle Awna or memdecbrred M1mre.
c; T y, l,� y��
Date signed (month, daY. Y��)
Dale si9rred (rronN, daY. Y��)
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