Homestead_Mason (3)C/�
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"'^ CLAIM FOR HOMESTEAD PROPERTY TAX
� , STANDARD/SUPPLEMENTALDEDUCTION
6 v SUte Fo�m 5473 (R1216-09)
�O � Prescribed by Ue Department M Lxal GovemmeM F�nce �
� �\\` � FORM Y�
"� Hc�a
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nva n[ui. `�vn�: .>tm reversn sme �or wu,y msuwwns. � �
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1(We) certify ttia�t�I(/wLe) oaupied as �my (our) prindpal
place of residence or am (are) buying the following desui I property for which a Homestead Property Tax a�npard De ti ' eby daimed
under q on Ihe date �his appiiplion is filed, (date o/fi/ing): �Q�P��
_ ` `a� GIBSON COUNTY qUDITOR
L�Yt ❑ Am (are) buying under recorded conVad
❑ Am (are) entltled to occupy as a tenanFStockholder of a cooperetive housing corporation
� Have a beneficial interest in the wst or the right to occupy the pmperty under the terms of a qualified personal residence Wst
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Nam f daunant (kgal name) � .
' Set�rity
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L/
Sodal
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If buying om m�tred, Fee Simple owners rame
Recordefs M6ce where convact is remrtled Recortf number Page
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Counry Townshi7 Tarirg S¢biG (Ul: Mwn. townahrV)
� �j(�J n/y[�n_be �-e9el Ee5oiD6o^ Is Ne property in Qu�tion:
�U {- O�� . O ❑Rea�PmPertY ❑AnnuaOyassessedmoWehome(IC6f.f-7)
If any ponion d Ne residential struWUe a Uce WM not exceetling one (1) acra ihat immedatety surtounES ihat swc¢�ra Is used m produce inmma, desWbe the usa aM porGOn
m me wcoem w�� �o a�a� �,�.
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Counry TownshiP Caunry Tamstup
I hereby certiTy the above statemenis are We, mmed aM complete. '�^a ;? o( daimam � �
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A (num6er antl ahce4 �1: �:e, end ZlPCOde) .
71 IS V50 W u�l �66
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Land not ezceeding 1(one) acre immediately � �� ��'���'��"��}��
surtoundin resfden8al im rovemen�. � � � -Yx�
F 7`�
Olher lantl (2) �,.,,`?�",-F��y:.
Total land (line 1 plus line i) (3)
ResidenUal improvements or Mnually �eliing (4) . 'e,��?�. ������'��y,��� i'�`�
Auesud Mohile / Manufactured Home �'��.c`���x" - ''xt��-?,.F �'-u''-�'££
Garege (5) i.`x.. �i. �^'��`s�_�: -'k�
+�4e':s".+'�
Other Improveme�KZ (6) � x,r;�;�i��:
7otal improvemenls (line I NiougA line � (7)
Tofal value (line J plls line � (8)
I hereby ceRity the above is We, cortect, Signature otnssessor oate signed (month, day, yea�
and complete.
Vaify'ug aaon - Si9naWre IN Niditw Date signed (monlh. daY. Y��
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20 pay 20 _ Lesser of 60% of the assessed value o( ihe homestead or 545, WO
NNwifislard'ug eny olher provision, fha wm o/the deducliw�c prov/tletl in IC &f. f-f4 to e mobi7e Mme Ihat is �
nof ncrosced as realWOpeM w ro a menu/arlured hortia fhat k not assessed es reel poperty maY �mt exceed " . ' ' _ _
o�e�an(�rz� ama ess�s�d �are d me moaae no� or �r,a��w�ed m�.�e.
sq�au,re or awn« oace s�y�ea c�,u�. aar. r��l