HomeMy WebLinkAboutHomestead_Whitten (8)""� CLAIM FOR HOMESTEAD PROPERTY TAX
__ � STANDARD / SUPPLEMENTAL DEDUCTION
� � SUte Form 5473 (R12 / 6O9)
�O � Prawi6ed by ihe Departmenl of Loral Govefmierrt Fironce
INSTRUCTIONS: See reverse side for fi(irg inshvctions.
FORM ��
HC10
FI�ED
•
I(we) certify that I(vre) i as r) prindpal
place of residence am ( ) buying ihe following desaibed I properry for which a Homestead Pmperty Tax Standard DeduUion is hereby daimed
under conVaG on the date ihis application is filed. � (date o/filrng): J��� �
❑ �(we) own ❑ Am (a2) buying under recorded conVact GIBSON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperalive housing corpo2tion
� Have a beneficial interest in the wst or the right ro occupy the property under the Jerms of a qualified personal residence Wst
•• • •
Neme at t (kgal nartre) -
Sodal Senairy nmDer Drivers I'cense / Identifratbn / Olher numEer Issumg Sate
ol daimam (Wst frve dgiGS)
Name of dac�unYs spouse (legal neme) ^��
Sadal Seamty numb� ot tlalmanPS spouse (WSf five Oigds) Drivefs Ikense / ICentifiratian I Oiher number' Issuing State
� 01 daimarrt's spouse (last (rve dqitsJ
• ••� �
11 buymg am m�treq Fee Slmple ownels �ame
ReCOtde�s of6rs.` `M�em cantrdG ¢ rem�deE � Recdd num6er Page
..�. . � . �
Counry Township . , Ta�m�g d�sbia (rity, lown. Iown.NiP) .
ParceJ fwwmber Le9al tlesaiPtian Is Uce property in Question:
� 1 '� ❑ Real pmperty ❑ MnuaAy assesseG modle homc (IC 61.1-7)
tt eny portion d Ne resdential stnrcN�e or t�e lantl not exreed4g ana (1) aae that murrediatety surtouMS Uwt sbucNre is useE tn yntluce imm�e, Eesrn'ha tfre use and poNon
of Ne P�PenY ubTaed tn proEUre inmrtre.
�-R ao
... . . : . .
Coumy Township Counry Townsitip
I hereby certiy the above statements are true, cortect arM complete. �' ��� _
re bei Mst�,tlfy, .e andLPCade) �,�
S. '
C�. e
� • • � • �
� � � i i . �
.�;.'�' J �-'. -.
Land not esceeding 1(one) acm immediately y,,. � f''*����.a��.l! ;a=�' � aF-
aurtoundin fesltlentialim roremenm. (�) -�'�-4^��<:a?..':�c�-r'.i.!'i�^':-'4'�
s1`�-c:.��ti. �s�5 }� �'
Olher land (2) � �:`�`;;3,,,'qp��c�
Total land (line 1 plus line � (3)
Dwelling (4) � `.�-r''�3�t�����'-+� �i Y ��
Residential improvements or Mnualty
Pssessed Mobik I Manufactured Hortre Garage (5) 1�� �-n�iA =��
�tc ��`ru� �s
C:T�-•� ?2• y „�`4
Other ImprovemeMS (b) �'�F;�*�-t"r,��s `�-�„^
Total improvements (ltne 4 Mrough Ilne � (7)
Total value (llne J phs line 7� (8)
I hereby certity the above is We, correct, Sg�� °f � �� �'� (�, �y ��
and complete.
VeSying aUim - SignaWre o(�tor Date siBned (monN. daY. Y��)
� . - � � � • •
20 pay 20 _ Lesser oi 60% of Ne assessed value of the homestead or S45,W0
No/xithstand'ug eny ofherpio�ision, the sum o71he tleticclions provrtA,•d in IC Ef. f-12 m a mo6�e hortre Nat /s $
nat assesced es real property w to a manulaCUied Irortie Nat a not assessed es real propaily maY � e+ceee . - " " '"
oneheH(12) o/ fha assassed rdfue o/ fhe mobtie Aome w manutaGUied home.
Sigrutwe d PLCItnr Date a9ned (mmN. daY. Yza�