Homestead_Harper (3)CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD/SUPPLEMENTALDEDUCTION
. . State Fortn 5473 (R73 / 12-09)
� Presrnbed by Ihe Department of Local Govemment Finaxa
ur
INRTRIIl:7fnN.0 .Cow mwrca dda (nr filirv� incfmNinns
FORM
HC70
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�(yyy) certify that I ) s y dpal
place of residence or e are) buying the following described reai property for which a Homestead Pmperty Tax Stan a u on is ere y daimed
��ae� ��r�a oo me aa� m� aPPrm�, � eiee, (dara arr�;ny�. i(we>: NOV 2 6 2012
❑ Own ❑ Am (are) buying under recordad conVacl
❑ Am (are) entitled to occupy as a tenenbstockholder oi a cooperafive housing corporaGon G'�.
❑ Have a benefidal interest in Me Wsl or the right to axupy the property under the terms of a qualified personal 2sidence Ws
❑ Am (are) the shareholder, partr�er or member of the entlty that owns Ne property. GIBSON COUNTY AUDITOR
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If buying on contract. Fee Simple awners'ame
RecorEers oi6ce where mnvaG is recoNea Remrd num6er Page
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Counh Township Ta�dn9 distritl (city, town, townshiP)
Pa�cel number Le I tlescrlpUon �n Is ihe propeNy in question:
�O�u.+�++�'� ��+Wfr I/ � ❑�I p�operty � AnnuaOY esussed rtnb0e ham UG S7. f-71
It arry portion o( tl�e �esidential structure or Ne IaM not e:ceeding rne (1) acre that immediatey sumwnds that struclure is used ro pioduce incoma, tlesrnbe 1he use aM portim
W Iha P�WanY uti�ed tn yoEUCe Ncoma.
d6- 19-3 !- voo-000. 83 �-�0 9
-.• . . _ . .
Caunry Township ��tY T�'^�P
I hereby certify Ihe above statements are We, cortect and complete. ^a�R of da' nt
Adtlress(numbere t,tiy, e,andZiPoode) .�I t�
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Land not esceeding t(o�re) aere lmmediauH �» ����"�"'�'�� ,��-f��?�;
surtaunAln realdentlal Im rovements.
t F.�.$.fw�'tK+a-_�i.'_
Othar land (2) .�, 5 < �. �-.., =,�,.:
Totnl land (ltno 1 p/us Ilne 1) (3)
v iR..^Y�" Ysa,t,a r. =.�}` `C% �i
Rceidentlal Im rovements or Mnuafly ���Ing (4) � Y.,s„c�4 �- a� 3� fo- . h:r -;
n�,sed Moc�ie I ��r�w�d r�re ��ge �5� . �r� � �i���-� � ���' �
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k?2�.' `t..i:L,'r""-.,i`rF.
Other ImProvements ifi) ;ar., <�t'fsr,i?��r�i•�
Totel improvemo'rts (!!rre I thiough line � (7)
romi �.awa pma 3 pr+s ime � (e)
I hereby certify the above is We, correct,
Signawre of Assessor Date aipned (rtronN. deY• Y��)
and complete.
VeiNin9 adbn - SS��re M Audimr Dam si9ned (monN. tlaY• Y'��)
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20 _ pay 20 _ Lesser of 60% ot the essessed value of ihe homestead or $45,000
NolwiMSiending any otherpovisbn, Ne wm W the Eeauctbrt poWetl in IC G7.7-12 ro e moW7e l�arre that is $
nof assassetl as real property or fo a menu(acfurad hame Nat is nof essassed es rael property mey rwf exceed
one-hetl f21 W Ne euessed vehie dNe moWh fame or man�dacmred home.
s�nsmre o a,a�cw oa�e s�nea (monrn, eer r�A
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