Homestead_Walker (2)CLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R13 ! 12-09)
� Prescribed by the Department of Local Govemment Finance
INSTRUCTlONS: See roverse slde for Bling instructions.
'i FORM Y�R
HC70
� I
I(Wel � /%l�/l�� t—T f J ��D �� certiry that i(we) occupied as m?((our 'ncipal
place of residence or am (are) buying the fiollowing described real property for which a Homestead Property Tax Standard Deduction is ifere y
under contract on the date this application is filed, _�(date of filing). I(We):
GIBSON COUNTY AUDI'
Own ❑ Am (are) buying under recorded contraet
� Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust .
❑ Am (are) the shareholder, partner or member of the entity ihat owns the property.
Name of daimant (legal nai
�
Sodel Seauiry number
of claimant (last five digits) �
spouse (last five diqlts) Driver's license ! Identfication / Other number
of daimant's spouse (last five dly'ds)
If buying on contract, Fee Simple owner's name
Recorders ofGce where contract is recorded
County
Parcel number
If any poRion of the residentlal structure or the land not exceeding one (t) acr6 th�
of�,e ��0�-/���'��a3-Da/��9 OQ �
County
Township
I hereby certiiy the above statements are We, correct and complete•
�dress (number and street, city, state, and ZIP code) �� n�� n
3 a � �,d,. �ti:a,-= �_) �%ni-C . f„ ��u
Land not exceeding 7(one) acre immedlately
surtnunding resldsntiai Improvemonts.
Otherland
Tofal land (/ine 1 plus Ilne 2)
Duvetling
Reside�tial fmprovements or Annuslly
qsssssed Mobile / ManufaCtu►ed Hcme Garage
Other improvemenfs
Tptal improvemerrts (llne � through /ine by
Tofat valua (line 3 plus pne �
I hereby certlfy the above is true, correct,
and complete.
Verifying action - Signature of Auditor
��)
�2)
(3)
(4)
(5)
(6)
��)
�8)
Signeture of Assessor
Taxing
County
� Ilssuin��
�
Issuing State
Record number Pe9e
(city, town, townshfp)
Is the properly in question:
� Real propeAy ❑ Annually assessed mobAe home (IC 6-1.1-n
nds at structure is used io prpduce income, describe the use and portion
�
claimant
�%GGo -��/ g
20 pay 20 Lesser of 60°� of the assessed value of the homestead or $45,000 I
�
Township
Date signed (month, day, yea�
Date signed (montl�, daY. freer�