Homestead_Garrett (9)CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�
__- STANDARD / SUPPLEMENTAL DEDUCTION � HCtO �
Sfata Fortn 5473 (R73 / 72-09)
�,�„ 1 Prescribed by the Department af Local Gwemment Finarxe V
INSTRUCTIONS: See reverse slde for fiiing insWCtions.
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I(We) ceAify e pied y ur) rindpal
place of r idence or am (are) buyirg the following described real property for which a Homestead Pmperty Tau nd daimed
^der contraG on ihe date this application is filed, (date of filing). I(We):
�own ❑ nm (are) nuyin9 under recorded contrect MAY 1 1.2012
� Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing corporadon C.� n�y�
❑ Have e benefidal interest in Me Wst or the right to ocwpy ihe property under Ne terms of a qualified personal residence t .
❑ Am (are) the shareholder, partner or member of the en5ty that owns ihe property. GIBSON COUNTY AUD
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Name o( �man[ (legel neme) '
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soo� �
Sodal Sewriry numhc of tla'vnanYs spouse (6st five d'glts) Orivers Bcerae / Identlficetirn / OMer numDer Issiilrg State
of da4nanYS spouse (WSt five dgiLS)
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If buyirg an contrdct Fee Simple ownefs name
Remrders of6ce where contraa is recorded Recard number Page
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�„r,�y Townsniv Tariny disti�i (ary, rown. rownsnip)
PamPJ number L I tlesaiplion S M� 4s the Ouestion:
/ N F E -/ Z- ❑�� u�m ❑ �,anr �e �,onoa n� c�c �-,.,-n
It a�ry portion af Ihe residential sWCture w Ne IarW not exceeding one (1) aae ihat irtunWiate�y surtounds tha[ sW�Ywe is used W P�uce mmne. OeSaiDe Ne use and poRion
a u,e �ny w�ed m aoe� moo�.
�_1 �- o?o - ao0-oo0..�� -02-/
-.• . .: . .
Counb Township • ��N . T�h�F .
I hereby certify Ne ebove statements are hve, cortect and complete. g^a of aim�nt �
h
Adtlress(num6erentlstree4�xN. ate MLPmde) L
�0�4� �.✓ � s� S �„-z� �; � �,1 I � 6� 5
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Land not esceeding 1(orrel acre Immedlatety �, ��, �.''� o�`xic4��:
surtoundln resldenUsl lm rovements. ��) s'"-�=-� '£ x'�.:. ``
Ss ° " ��+?''" "
Other lantl (2) "1. r7�,`,�', "t -;
Total land Qine 1 plw flrre 2) (3)
1F`j� `i�r ° `t$ �j5 `c. ^'f
ResideMiallmprovementsorMnualy �IIIn9 (4) 4��-^�-3?,�':�g�,i �rg,:,-��
Asaeased Mohile I Manufaclured Home Ga�9e (5� ��° �4�r �,,� n;� �"�'`c}.'-��4�-.',.
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Other Improvementa (6) � � . y �s- �'z''''�`a:
Tofal improvemerrts �1lne I Nrough line 6j (7)
Total value (line 3 pha Ilrre n (8)
I hereby cerdfy the above Is We, correct, �9^a� oi Assessor Daie ti8^ed (rtro^N, daY. Y��
and complete.
Verifying aclbn - Sigreture M/wdimr Dam signed (month, day, yee�
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20 pay 20 _ Lesser of 60% of the essessed value of the homestead or E45,000
Nolxithstand4g airyWher povision. Ne sum o(fhe deductions proNded in IC 6/.7-12 fo a mobr7e horne that is $
nof asresseO as real property or fo e menulMUred home Naf is nof essessed as reel property may not exceetl
one-hatl (f2) d Ne essessed vehre o/the mo6de hortre wmamdactured home.
��e��� Date sgnetl (month, day, ysa�
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