Homestead_Taylor" CLAIM FOR HOMESTEAD PROPERTY TAX
_- ? STANDARD / SUPPLEMENTAL DEDUCTION - I9
State Form 5473 (R12/6-09)
�� , ,• Prescribed by the Department of Loral Government �Finlannce u
INSTRUCTIONS: See reverse side for filing instructions. ( 1 A �X�
FORM YEAR
HC70
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'.ERTIFICATION STATEMENT
1(We) Lie jo AZ CZ certify that I (we) oc xipied as my (our) principal
place of residence or a (are) buying the following described real property for which a Ho stead Property Tax Standard`Oeda claimed
under contract on the date this application is filed, (date o/ g):
❑ 1 (We) own ❑ Am (are) buying under recorded contract GIBSON COUNTY AUDITOR
❑ 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
INFORMATION
Name of claimant ( /L I
Social Seanity number of dawpnt (fast foe d6b)
Drivers laonse I Identification I Other num
Issuing State_
/
of claimant (Iasi five digits)
/
spouse
Name of claimant's s pusC (legal name)
Security number of daiirmant's spouse (last five digits) Drivers license I Idenuficatfon / Other
/
RECORDED
If buying on contras, Fee Simple owners name
RemNers ofice where contact is recorded Record number Page
PROPERTY DESCRIPTION
Co
Township Taxing distrid (' town, toynshi
ParW number
description
Is a party in question:
W -00
I I property ❑ Annually assessed mobile home (IC 6.1.1 -7)
anly porpor, of the residential structure or the Lend not exceeding we (1) acre that Immediately wnOnrlds that saUCblre Is used to produce income. describe the use and portion
®If
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County Township
I hereby certify the above statements are true, correct and complete.
S' nor d
. Address (number and street, dy, yalec and LPoode) -
1L% C d /Aht/.Di
•
•
Land not exceeding 1 (one) acre immediatetysurroundin
residential im rovements.
73�-z7
Other land
O
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'.3Ct k�axb3 $rt r.uY'✓,: >xf`-.
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
, I
yx•_Or�i" ".
Game
Other Improvements
(6)
.._may :++kat �'; �•
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plea line 7)
(6)
1 hereby certify the above is true, correct,
Signature, of Assessor
Signature,
Data signed (momil, day, year)
and complete.
Verifying action - Signature of rwditor Date signed (month. day, year)
.. -.. MI 1111611161 If 111 ill kiillyl_�!P
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45.000
NoNAthstanldeg any otherpmvision, the wm of the deductions provided In IC 6-1.1 -12 to a mobile home that is $
not assessed as real property or to a manufactured home that is not assessed as feel property may not exceed
one-had(12) of Me assessed value of the mobile home ar manufactured horn.
Date (r�dlr. 4aV
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