Homestead_Adcock (2)CLAIM FOR HOMESTEAD PROPERTY TAX
� _ STANDARD/SUPPLEMENTAL DEDUCTION
S� State Fortn 5473 (R72 / 609)
S P Presaibed hy the DepartrtreM of Local Govemme�ri F�anca
INSTRUCTIONS: See raverse side /or fifing insfn�ctbns.
1' �L9�1�'
JAN 2 RM
Hcio
GIBSON COUNTY AUDITOR
YEAR
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I(VJe) certify that I(we) occupietl as my (our) prindpal
piace of re nce or am (a n e follawing des�ibed real property for which a Homestead Property Tax Standard Deduclion is hereby daimed
under mn on ihe date ' ppli 6on is filed, (date o/filing):
e) own ❑ Am (are) buying under recorded conVact
Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporetion
� Have a benefidal interest in the Wst or the right to occupy Ihe property under the terms of a qualified personal residence Wst
•• � •
Name of daunani (legal name) ' .
Sodal Seamry nm�bri dda'
)
Sodal Seauity numbnl ot daimanYs spouse (Ws( five drg'rts) Dmafs Ikense / Iden6fratbn I Oiher number Issuing State
oi ciaimanrs spouse (lau five etgitsJ
• ••� �
If buying rn mnireq Fee Simple ownefs rame
Recordefs of(rc where mntraG is recorde0 ' �Recortl number Pa9e
..�. . � . �
���y Tawnship Ta�dng disirid (fi(y, town, fownship)
ParrnJ number Legal EesaiP� Is e perry in Quesiion:
' I property ❑ MnuaOy essessed mobile Mme (IL &1. f-n
If any portion ol Ne residentlal strucWre or Ne WnE not excee0'ug a�e (1) acre ihat immediately su Cs Nat st�umre is used W produre incame, desaihe the usa and poNOn
of Ne P�Pe�Y uti!¢ed m proCUCe inmme.
� �=a��-d� y�a�oa ,S3o�
... . . : . .
Caurrty - Twmship Counry Taxrt^.Np .
I hereby certify the above statements are We, corteG and complete. �"a� of tlaimant �
dreu (number ard sheet, ciry, stffie, aM LP cotle)
� • . � • �
• � ii'. • �!�.�{
Ldf1AlIOSGYC!!EI(191�0/IE�dCRIffITldI3LGIY ' ��f��g hOj�ry�•�i-ES��X
surtoundin residential im rovements. �) �`�rx<�s.'�.�-:$:�}n'tS-.,' e.-i �;.
0. ��.i,
Y . ��
Other land (2) r�'�,xy�.'��'P�"4w
Total land (line f plus line 2) (3)
9 � ) � '��'.�}'. i° � ���Cr3.r. . t w�c
ResidenUal improvementa orMnualty ����� 4 ��'� ����
0.ssased Mohile I Manufactured Hartre �g�i-""{ �• �%."'�'� .�
Garsge (5) ri'°5�'�i't3�.t1Y"c'n�''r.°��'.��"'�3'i� _
� �r,_r �:
Other improveme� (6) :�1'.'":S�c�i'hT"x�°��Y� ,
Tofal improvementa (line d through line � (7)
Tofal value (line 7 plls line n (8)
I hereby certity the above is We, correct, Signawre oiPSSessor Date WgneE (month, Oay, yea�
and wmplete.
VaifyWi9 aman - SigrayR oTAUtlimr Date si8�� (monN. EaY. Y�)
�..� � � • �
20 -pay 20 Lesser of 60% ot the assessed value of the homestead or 545,000
NohwChstanding any otherprovision, Ne sum W Ne �etlWions provk4d in IC G7./-12 ta a moblle hor+re Nai b. $
nat asmssed as real {wperty or to a manNacturad horne fhel a nof asseued as real popeny maY rrot asceed
one�haH(72)dNeassessedvahrea7Nemobiehomeormanutaduredlrortie. �
Signavrte of Puditor Date s8�e0 (manN. EaY. Yea�