Homestead_Henson" CLAIM FOR HOMESTEAD PROPERTY TAX
� ._�• � STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R7216-09)
�' � Prewibed by ihe �epariment of Laal Govemment Firiance
INSTRUCTIONS: See 2verse side forTding inatruclions.
FORM YEAR
n �
. , � ,
I(VJe) � certity ihat I pi �{!my(our) prindpal
place of residence or uying t e following described real property for which a Homestead Property Tax Standar� ��d�di tT�shereby daimed
GIBSON v
under conVac[ on Ihe date Ihis appli n is filed, (date of filing): COUN7Y AUDITOR
�(VJe) own ❑ Am (are) buying under recorded conVact
Am (are) entitled to occupy as a tenant-stockholder of a cooperalive housing wrporation
� Have a beneficial interest in the Wst or the right [o occupy the property under Ne tertns of a quali(ed personal residence Wst
•- � �
Name f a'unant ( al name)
Sooal ' nim�bri ' nt (
Sadal Sewnry numbesof daimanfs spouse (last five tl'gits) Orivefs license / Itlentificalion / O�her number Issuing Stace
bf daimanCs spouse (las( Irve digiLS)
• ••� �
tl buying om m�tract, Fee Simple owners name .
Rem`defs ofirce where contracl is recorded RecorE number Page
..�. . � . �
T iP T' disiria (crty, fo . fownship)
Parcel number Legal descripUOn Is �he property in quesvon:
a--/ - oG- o Q - 0 eal property � Annualty assessed rtrobile home (IC 6-1.7-7�
�11 any portion ot Ne residenlial swctura w Ne IaM not exceeding one (1 j acre Nat immetliately surtound �hat swcWre is useA co produce income, desrnhe Ihe use and portion
of ihe pmperty uGfaed m pfodure inmme.
-�• • � : • •
Counry Township Caunry Trnmsltip
I hereby ceNTy the above statements are [rue, correct and complete. Signa r of daima '
Mdress (numb a st t-, slate, antl ZIP code) �
� • . � • �
•• •
��'. �
Land not e:ceeding 1(one) acre immediatey � �-��'�..-3i ��?"=� ����'��."E-"�,
sunaundin residmtial im rovements. ( � �=-4 �-�-- _ -- Y- �� �:�
�� � '
Otherland (2) �..#+��v��rwi�" .
7ota1 lantl (line 1 plus line � (3)
<r�.-`�" "4� y�3.`�''- T LT-.f�' �"ge:
Dwelling (4) ._.��`''.�c �`<. ���a „�'.N � r`�'i �,.�-
Residential improvements or Annually -_ '
Pssessed Mobile I Manufacturetl Home 4''�"''�'� "F`�`
Garege (5) �'' ��� �s��Ac;� •` � �.:""e�,
.�..c.c�.... �•�.::'I :
Otherimprovements (6) �°'ri.. s�:�y�C�
Total improvements (llne 4 Nrough line � (7)
7ota1 value (line 3 pl�s line n (8)
I here6y certify the above is true, cortect, Sigriawre ofAssessor Da sgned M, y,
and complete.
Vailying acrion - Sgnamre of Pudimr Date signetl (monN, day, yr.aQ
...� � . . .
G na
20 pay 20 lesser of 60% of the assessed value of Uie homestead or $45,000 �� �,{! .
V
NotwifAstandinganyotherpmvisiron,ihesumofNededucri�nsprovitleeinlCGiJ-f2roamobdelromelhatis g GIBSON COUNTY AUDITOR
mt assessed as real propeily or fo a manufaGUred hame that is raf assessed as real property may not erceed
one-hatl(1R) o/Ne assessed rdlue olthe mobde home ormanulacturetl hwne.
SignaWre otNMitw Date signed (rnonth, day, yea�