Homestead_Martin�'"' CLAIM FOR HOMESTEAD PROPERTY TAX
.�° ._ = STANDARD / SUPPLEMENTAL DEDUCTION
� State Fartn 5473 (R72 / 6-09)
�O •� Preu,ribed by 1he Depanmen� ol Loml Gmemment Fiance
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y ���LUtO YEaa
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INSTRUCTIONS: See reversa side for�ding insvuctions. G�gSON COUNTY AUDITOR
.
I(we) �i- ceNry ihat I(we) occupted as my (our) prindpal
place of residence or am (are) buying the following desaibed real properry for which a Homesiead Property Tax Standard Deduction is hereby daimed
under conVac� on ihe date Ihis applintlon is filed, (date o/filing): �
� I(We) ovm ❑ Am (are) buying under remrded conVact
❑ Am (are) enGtled to occupy as a tenant-slockholder of a cooperative housing corporation
� Have a benefidal interest in the Wst or Ihe right to occupy Ihe property under ihe tertns of a qualified personal residence Wst
•• • •
Name of daimant (k9al ) M
r�q I � IQr
So�l Seoudy ruurter
Name of da'urunt's�spyn�� se (I�ia/ name)
/�/1/�Q�Q �Qh
Sodal Seamry
i N
. .-, .
tl buying on convacl, Fee Simple awnefs name
Recordefs oRxe where conUact is recor0ed Reeord number Page
..�. . � . �
���, Township Tadng tlistrid (�, rown own5hip)
Parcel numher Legal EewiPtion Is Ne proPerry in W esvm:
' R¢yl prpperty ❑ MnuaAy assessed modle home (IC 6-1./-n
�It any portian ol Ne rPSidentlal sWCWre or Ne IaM not eYceed"ug orre (1) aue that imme0ialely w nds Ihat sWC4lre is useG to p�oAUCe ifroort�e, tlesuibe �he use aM portion
of Ne property uu!¢ed tc pioCUCe inmma.
a �-�7-03 -�ao-a�3 `9 �a-oa I
... . , : . .
Counry TawnshiP Counry 7oxnship
I hereby certify the above statements are We, cortect and complete. Sig�[yfe of daima ^ '
Y� /
ss (numGer and sfreet, cRy, sfate, anE LPCatle)
95 G<l, �150 5 i �i /e —� N�i'7lol0 �
� . ., . �
•- • �� ..
pvN
land nat e:ceeding t(one) acre immediatery (� � �i� �,,, �'�a,M� ��`��
sunounAin residential im rovements.
`�i ^;�s�'.r' {fq'�'
��`�?':"� �
Other land (2) :.a<.:,s,,, I:s ��.i
ToGi land (line 1 plus line � (3)
Dwellin9 (d) #}1':� .'""f""w i3c� �' ��TEt'��
Residendal improvemenis or Mnually � -.
Ass�sed Mobik I Manufactured Homa Garege (5) a j.=.�,� dp,'^,'�y�2v�,,,S� �,� {�
' �, r'- a: i =:;��=�e:;:'>'
Otherimprovements (6) Ty i`;?C_�:*<:��^%+;;�
Total improvemenCS (line a through Ilne � (7)
Total value (llne7 p0a 1(ne 7) (8)
I hereby certity the above is true, cortect, Sig�ture otASSessor . oa;e signed (rtronth, tlay, year)
and complete.
Vaitying action - Signayre o/ PLdtw
Dafe signeE (monN, tlay, yea�
� . - � � � • •
20 _ pay 20 _ Lesser of 60% ot the assessed value of Ihe homestead or $45,000 .
NolwilhslaMin9 any other pro�.isbn, fhe sum dNe tlaductbns proMeO in IC Gt. f-7Y ro a mob�e lame that is g
nat assessed as real propeM a ro e menufactured hortre Nat is rof asseued es real ploperty may rwt erceed
onahaR (72) o! fhe assessed ralue o/ Ne moblle home or manNaGu2tl hama.
SignaWre otAUdltor
Date signeC (monfh, day, yea�