Homestead_BraswellCLAIM FOR HOMESTEAD PROPERTY TAX
` STANDARD / SUPPLEMENTAL DEDUCTION
i State Form 5473 (R12/6-09)
° Preswbed by the Department of Local Government Finance I 12
INSTRUCTIONS: See reverse side for filingins tractions. 1^rct Wes\ 1
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II II 1 2010
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-ERTIFICATION
STATEMENT (I
I (We) certify ��( //(wwe�e) as my (our) princlpal
'ng
place of residence or am (are the following describ eel property for which a Homestead Property Taa rida lu n is 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
❑ Have a beneficial interest in the trust or the right to occupy the property under the tenns.of a qualified personal residence trust
INFORMATION
Name of claimant I name) ,
I
Social Seaaity
Social Sec uiry number of cla t' spous st five digits) Drivers license I Identification I Other number,
CONTRACT RECORDED
If buying on contract Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County CS7r�
Township Taxing disbid (city, to t ip
P&fW umber,
/l01
d 'Ption
tape property in question:
O(U rL
.
I property ❑ Annually assessed mobile tome IC 6-1.1 -
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tt any portion of the resklendal suuc u,re or the land not exceeding one (1) acre that immediately surroutids that structure is used to produce income, describe the use and portion
Of the property utilized to produce Inccmie.
PROPERTY r BY CLAIMANT
IN OTHER COUNTIES
County Township
County Township
1 hereby certify the above statements are true, correct and complete.
Sigma imam
dress (number and same; ctt1: LP code) 1
Gr c
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Land not exceeding 1 (one) acre immediately
(1�r
surrounding residential improvements. ..-
Other land
2
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Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'f , ci44 44?' m
Residential Improvements or Annually
Garage
✓°ra.�+.Ft
Assessed Mobile Manufactured Home
(5)
w�''r ,T���vr.
Other improvements
(6)
- >' -mow' 1-�•:
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 pis line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Date signed (month, day, year)
and complete.
Venlying action - Signature of Auditor
Data signed (month. day, year)
STANDARD • r
20 _ pay 20 _ Lesser of 60% of the assessed value of the homestead or $45,000
Nofwtihstandirg any others mvition, the sum of the deductions provided in IC 61.1 -12 to a mobile Mme that is
$
rot assessed as mat pmperry or to a manufactured home that is not assessed as real property may not exceed
on 12) of the a u of the mobile Mme or manufactured home.
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Data si99 "��' \)
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