Homestead_Dill0
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R13112-09)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
l
I (We) certify pied y ur) 'n ipal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax nd claimed
Eder contract on the date this application is filed, (date of filing). I (We):
MAY 9 2012
Sown El Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation C(,^
F-1 Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence
❑ Am (are) the shareholder, partner or member of the entity that owns the property. GIBSON COUNTY AUDITOR
Name of clai (legal name)
Social Socially number of dannant (last me dgits)
Driver's license / Identification I
Name of dalmant's spouse (legal na
Social Security number of claimants spouse (last rive digits) Dover's license I Identification / Other number Issuing State
of claimant's spouse (last five digits)
If buying on contrail- Fea Simple owner's name
Recorder's office where contract is recorded Record number Page
County Township Taming district (City, town, township)
Parcel number
Legal description
Is the property i uestion:
/q —ho . S7 ,¢
❑ Real property ❑ Annually assessed mobile home (IC 6-1.1 -7)
If any portion of the residential structure or the tend not exceeding one (1) ace that immediately surtounds that structure is used to produce income, describe the use and portion
of the property utilized to produce Inceme.
IN&-05- 57- 09Lf -000. /&Y-0/7
.MINE .:
County Township
County
Township
I hereby cerfify the above statements are true, correct and complete.
Signature ofd truant A w
: k (% - e o � Z� � 7 6 V It9
Qiii a , state, and ZlPcode)
., Ravi
Land not exceeding 1 (one) acre Immediately -
(1) r= "�'r"� -':ors �'
surrounding residential improvements. _• -'��
Other land
(2)
Total land (fine f plus line 2)
(3)
Dwelling
(4)
F,SG ii SY L_ �sA J
Residential improvements or Annually
F -^,{'s '"-^'�"+`�. "'s`-
Assessed Mobile I Manufactured Home
Garage
(5)
•�:
Other Improvements
6
Total improvements (line / through line 6)
(7)
Total value (litre 3 plus line 7)
(8)
1 hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Verifying action - Signature of Auditor Data signed (month, day, )ear)
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwithstanding any omerprovisiorr, the sum of the deductions pmvmbd in IC 6.1.1 -12 to a mobile home that is $
not assessed as real property or to a manufactured home that is cox t assessed as real property may not exceed
one -half //t) of ire assessed value of the mobile fame ar manufactured lame.
Signature of Auditor
Date signed (month, day, year)