Homestead_Griswold CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
STANDARD/SUPPLEMENTAL DEDUCTION r. HC1O
State Form 5473(R13/12-09)
r- Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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€tt- s 4.A 4:t -i,CERATION STATEcN� Y3 .� r> )l t-
I(We) 0.21MtgefardirliallInON
certify that I we occupied as my(our)principal
place of residence or am le)buying the following described real property for which a Homestead Property Tax S rdrrc)2 i28i4 is hereby claimed
under contract on the date this application is filed, (date of filing). I(We):
❑ Own ❑ Am(are)buying under recorded contract
❑ Am(are)entitled to occupy as a tenant-stockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR
❑ Have a beneficial interest in the trust or the right to occupy the property under the terms of a qualified personal residence trust
❑ Am(are)the sh>arreholder, partner or member of the entity that owns the property.
' ;
:--:
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
^S. ri"Y'- a - sa .>bx -:e 'LSr_'4: 'Sri s : PROP,ERTrYYDEscR1PaTION : ." X72 F �i•.'-�tt s v,h3r ,*-a: ,. a=mm`ta; a�r�yx,=,'F
Township Taxing district(city,t. 'n,to County .4 •4 t //S1 I I
1/t-ud 1.4� 1'Q�T on Is the (•uestion:Legal'([JAS eat property ❑ Annually assessed mobile home(IC G1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds at structure is used to produce income,describe the use and portion
of the property utilized to produce income. ���=i
r, ' a`' ` > `.ynalt' ,PRtiPil T,YEO,WNEDIBYiC M/?- N OTHE R;COUNTIES --'i.i a ttzt-. 1 ' b `,-: .,r#
County Township County Township
I hereby certify the above statements are true,correct and complete. Signaure of da ant
Address(number and street,city state,and ZIP code)
a "� -' `7 - MANTI SSESSEDIVALUE i HOM ESTER f�'k'`* NON RESIDENTIAL+-j., 'Y
f rAS.7Wyl USE:ONLY: ��?RUE TAX;VAL'UEi I '
4,_��py ��y__ am AT 700,°/,OFxT.TV'r.i'�ctaiVAL`•UEaa s v �5._ �VAL'UE Land not exceeding 1(one)acre immediately (1) e i - -may-r 4 - li:,
surrounding residential Improvements.
3
Other land (2) ;
Total land(line 1 plus line 2) (3)
is
Dwelling (4) f ixn tY Ai tic.
Residential Improvements or Annually te:
Assessed Mobile I Manufactured Home Garage (5) W ,_w a y -.
f c�r> ;
Other improvements (6) -t-a�< -- °- -f'
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
Signature of Assessor Date signed(month,day,year)
I hereby certify the above is true,correct,
and complete.
Verifying action-Signature of Auditor Date signed(month,day,year)
. t: c�.s- ,Y-a St-tr io. , f .. ik:STANDARD)DE Pi!CTION ALLOWANCE_jyt1S ;. • k, c ;•,s'a," ? ,`e..4 '
20 pay 20 Lesser of 60%of the assessed value of the homestead or$45,000
Notwithstanding any other provision,the sum of the deductions provided in/C 6-1.1-12 to a mobile home that is $
not assessed as real properly or to a to manufactured that is not assessed as real property may not exceed
one-half- (y)07 the assessor!rafue o7 thC�J/ '\./� or manufactured home.
Date signed(month,day,yea
4r'tor , 68 ca-N