Homestead_Burgess0 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEA
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
0 Prescnbed by the Department of Local Government Finance JU I 1..it E
INSTRUCTIONS: See reverse side for tiling itnilructiotts,
",-s`' I 'I v I I CERTIFICATION STATEMENT;:. -'. .. 24,-M5 - . . .
I (We) certify th March, 20
hereby
I (We) occupied our principal place of residence the following describ d eal property for which a Homestead Prope Lv C,,e d i daimed,
T 4 C
❑ l(We)owned ❑ Are buying under contract GIBSON cOUNTY 4 PlVh.
6 KI
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACTI RECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
zPROPERTY DESCRIPTION-1
County
Township
HOMESTEAD
'VALUE
Ta g dit * low". tqo(eship)
Township
I hereby certify the above statements are true, correct and complete.
vauation or $35.000
IC(t�ty
Address (number and street, city, state, ZIP code)
Loaakdrs do
Is the property uestion
mr— ;Q
,
')
Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the resitlendal strucWre w the Wnd not em ceding 0
of the property utilized to produce income.
(1) acre that'=79dj . ately surrounds tf�at strulctw-e is used to produce income. describe the use and portion
O(L4 h
- //- ,
2��J�a- - 4�/
:PROPERTY OWNED BY CLAIMANT IN OTHER"COUNTIES
County
Township
HOMESTEAD
'VALUE
County
Township
I hereby certify the above statements are true, correct and complete.
vauation or $35.000
Si aI 3 I claimant
.
Address (number and street, city, state, ZIP code)
Other land
-STANDARD. DEDUCTION ALLOWANCE` -'-
TRUE TAX
VALUE
ASSESSED VALUE
AT100%OF.TTV-
HOMESTEAD
'VALUE
NON-RESIDENTIAL...
ALUE1,
Land not exceeding I (one) acre immediately
surrounding residential improvements.
vauation or $35.000
Signature of Auditor
Other land
(2)
Total land (fine I plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4)
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
-STANDARD. DEDUCTION ALLOWANCE` -'-
W 20 Pay 20
Lesser of 112 Homestead
vauation or $35.000
Signature of Auditor
Date signed