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--CERTIFICATION STATEMENT
FORM YEAR
HCIO
y on he Is 3 March 2 0
0
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SON CO
certify "GIBSON COUNTY AUDII08
bed real �propedy for rwh,,h Homestead Im Occupied as mtprin�apalplace io�festdece the �fllomig d� �a
RI(We)owned ❑ Are buying under contract
Mave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY.DESC RIPTION
County
Township
CLAIM FOR HOMESTEAD PROPERTY TAX
Parcel number
CREDIT /STANDARD DEDUCTION
I description 1, the property in question:
State Form 5473 (R5 I 1MI)
J,,
Prescribed by the Department of Local Government Finance
If any portion of the residential sWcture w the land not exceeding one (1) acre that immo y surrounds that structure is used to produce income, describe the use and portion
INSTRUCTIONS: See reverse side for filing instructions.
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--CERTIFICATION STATEMENT
FORM YEAR
HCIO
y on he Is 3 March 2 0
0
/, � d:
rty a
,:t ety
0 e ;tmb
SON CO
certify "GIBSON COUNTY AUDII08
bed real �propedy for rwh,,h Homestead Im Occupied as mtprin�apalplace io�festdece the �fllomig d� �a
RI(We)owned ❑ Are buying under contract
Mave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY.DESC RIPTION
County
Township
Taxing d (city, to" township)
Parcel number
Le
I description 1, the property in question:
W ss (number and street. city, st te, IP code
1 A
J,,
6 Real property l ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential sWcture w the land not exceeding one (1) acre that immo y surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
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PR61PERTYOWNED BY CLAIMANT
County - — ----- - -----
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Si cure of cla t
W ss (number and street. city, st te, IP code
1 A
�,&`!r`VALUErv�`:�
i
f , 49 -_V' -., 1
�J,��.; �STANDARD: DEDUCTION It I 1� . I� - ,
20 _ Pay 20
Lesser of 112 Homestead
$
Valuation or $6,000
Signature of Auditor Date signed
Z,,�.TRU E-TAX,,�'��'.;:
ASSESiE6-.VALOE
AT
-";—H()M- EST`E_A6'*
'�A"?IFA5�-��hVALU TIAQ,-,
_Y�%SSMUSE'ONLW
t K."
Z�
100%'OFXTV�
�,&`!r`VALUErv�`:�
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
ROW
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true. conect, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
f , 49 -_V' -., 1
�J,��.; �STANDARD: DEDUCTION It I 1� . I� - ,
20 _ Pay 20
Lesser of 112 Homestead
$
Valuation or $6,000
Signature of Auditor Date signed