Homestead_Besing (6)C
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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�;__.. STANDARD / SUPPLEMENTAL DEDUCTION
State Fartn 5473 (R72 / 6-09)
�� � Prescribed by Na Department of Laal Govemmenl Frence
lNS7RUCTIONS: See raverse side lor filing instrvuions.
FORM YEAR
HC10
'�e� F LED
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i(We) certiry thCet I,(we ied as my (our) prindpal
place of residence or am (are ying the following described operty tor which a Hom ead roperty Taz Sta �- a u is hereby daimed
under conUacl on ihe date this plicalion is filed. (date o/ filing :
❑ I(VJe) own ❑ Am (are) buying under recorded coatract � GIBSON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interest in the Wst or the right to ocwpy the pmperry under the terms of a qualified personal residence Wst
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If buy'o�g on conhad, Fee Simple wmels iume
Rem�tlefs o!&c where mntract is recorEetl " Remrd numher Page
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Town5luD Tadng tli54iG (uA: town. M _ 1^ .
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/�w�rt'�jyer� /y� Le �jal �tla/m�ption�� � Is Ne property in Question:
lp�/ �� � W "C� -W1� �� P�VertY ❑ MnwOy aSSessM mobile home (IC bt. f-7)
If arry portion W tha resCenUal sbudure n ihe WM no� ezceed4ig one (7) ace that rtnmeGiatety surtou that swaure u useC W produce u�mme, desrnDe the use and porUOn
o,�,e��m������,e. p510-co� .
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CauMY TamshiP Counry Tmmship
� I hereby certiy the a6ove ststements are We, cortect arM complete. Signatu of d' am �7 �
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Address (numLer and sL�et, aysfate, e ZlPcode) - . .
O S 5� S
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Land not ezceeding 1(one) acre Immediately �Y. � y=��'�.,-",�e.rf ;'` 'x
surtounAin resitlentialim rovements. (�) �,.���i.z�'��r�-�x'"�r'�i.r;
Other land (2) ' g3�.,s� �':F� j. � � _,,�,x .
Total WrM (fine 1 plus line � . (3)
) +e. ?'�'S.7'j' NY
ResiaeMiallmprovementsorMnualty �Iling (4) ��i'?F�-�:�x�'�j ..ht��
Assessed Mobik I Manufactured Home Gara9a 5 ��':, �"����F��'����,�'
( ) �:. ,, ia �.'`�
OUer Im rovemems 6 �'%��'
P ( ) r��`-`�i+�a^:r,.s:+.
Total Improvements (line 4 througA Ilne � (7)
Tofal value (Ilne J plus Iine � (8) .
I hereby certify the above is W e. cortect, Sqrahue of Pssessar _ Date s�gned (month. CaY. Y��
and complete. �
Veifying adion - Sigrewre of PLQtw Dale signed (monN, EaY• Yea�
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20 _ pay 20 Lesser of 60% of the assessed value of the homestead or $45.000
NuMilhVantlug eny afherproeisbn, Ne sum of the tleducL"ons prm�ided'm IC 61.1-12 to a rtm6de home Nal # $
not essesse0 az rael po rty w(o a menuleUUred hortre Nat a rot euessetl es real ryoperty mey rrot erceeC
tl(f d a relue themo6defwmeamanu7afturedlnrt�e. yp�
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