Homestead_Peavler" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
Stets Form 5473 (R12 / 609)
® S Prescribed by the Department of Local Government Franca
INSTRUCTIONS: See reverse side for firing instructions
FORM
F I HC,U
YEAR
1
CERTIFICATION STATEMENT
I (We) Q11 tznrry pied as my (our) principal
place of residence or am (are) buyi the following described real property for which a Homestead Property Tax Sta ucbon m hereby claimed
under contract on the date this application is filed, (date of filing): GIBSON COUNTY AUDITOR
❑ 1 (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
p Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Nam o t( Ina )
Social Security number of claimant's spouse (last Ave dgds)
Driver's ficense / Identification I Other number
Issuing State
of d24nanl's spouse (last five dlgits)
CONTRACT ••r s
8 buybg an mntract. Fee Simple owner's name
Recorders office where contract is recorded
Record number Page
PROPERTY
DESCRIPTION
County
Township
Ta=g d' (' town, township)
e�I number
Legal d ton
/
Is a property in question:
/y'' �^
tQ-WI — Do
. ICY
I I al property ❑ Annualty assessed nxUe home (/C 6-1.1-7)
if any portion of the residential stmctore w the land not exceeding cne (1) ace that brarm telly sunou Nat stmcWm U used to proArce income, describe the tree and portion
of the property utilized to produce income.
PROPERTY OWNED BY
County Township
Coumy Township
I hereby certify the above statements are We, correct and complete.
Signatu TAf claimant
Address (number ndsime4 city,state, and Zlperds) 01 V
25 U_�_ � — (7ft
ASSESSOR ONLY r HOMESTEAD TRUE TAX VALUE
ATIOO'/.OFTTV VALUE VALUE
Lend not exceeding, (one) acre immediately - -
surroundina residential Improvements.
Other land
(2)
- - -
Total land (line f plus line 2)
(3)
Dwelling
(4)
_ -
Residential Improvements or Annually
Garage
(5)
-- ''•'
AssessedMobilelManufacturedHome
-
Other Improvements
(6)
- -
Total Improvements (I /ne 4 through line 6)
(7)
Total value (line 3 pica line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signatrm of Audimr
Dace sqned (math, day. year)
STANDARD DEDUCTION ALLOWANCE
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
NohWhsfandi a env other aovitlon- the sum of the dedi ebans annIded 0 IC 6.1.1 -12 to a rrrobrb I rtar t• S
1