Homestead_LamonCLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�
_ STANDARD / SUPPLEMENTAL DEDUCTION HC7o
State Fortn 5473 (R13 / 12-09)
`� N prescribed by the DepartmeM of Local Govemment Finance
INSTRUCTIONS: See reverse side !or Bling instructions.
. �
��e� ce at ( o principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby daimed
under ct on the date this application is filed, _____ (date of filing). I(V11e): � E C� 2��2
Own [] Am (are) buying under recorded contract
� Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation C'�'
❑ Have a beneficial interest in the trust or the right to occupy the property under the teRns of a qualified personal residen �
Q Am (are) the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
Record number I pe9e
Parcel Mm_ber�f ^ � Legal description Is the property in question:
� �� �' Y^�/D�. ,0 �� ��' Q O� ❑ Reat property � Mnuaily essessed mobile home (IC 6-1.1-n
() o� l
If any portion of the residen8al s4vcture or the land not exceeding one (1) aCre lhat immediaiely surrounds that structure �s used to prpduce mcome, descnbe the use and portfon
of ihe propeAy utilized to produce income. �;:` �` �K� /e/W
Y��f'g
County
Township
I hereby certify the above statements are true, correct and complete.
Address (number and st,r�t, city, stafe, a�l ZIP
Land not axceeding 1(one) acre immsdletely
Ofher land
Tofal land {iine 1 plus Ilne 2)
DwqlUng
Resider�tial (mprovements or Annuslly
Assessed Mobile / Manufacfiured Home Garage
Other tmprovements
7ota1 improvemerrts (11ne 4 through Ifne by
Total value (line 3 p/us llne �
1 hereby certify the above is true, correct,
and complete.
Veri(ying acUon - Signature of Auditor
(1)
(2)
(3)
(4)
(5)
(6)
�7)
(8)
Signature of Assessor
County
claimant
2p pay 20 Lesser of 60°� of the assessed velue of the homestead or $45,000 I
A
Township
Date signed (month, day, yearj
Date signed (month, day, yea�j