Homestead_Martinr'
CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD /SUPPLEMENTAL DEDUCTION
State Fomn 5473 (R121609)
"O Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
f0
i
NOV 1 2 2010
CERTIFICATION STATEMENT
I (We) certify that y (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standa educe tpy claimed
un../der contract on the date this application is filed, (date of filing): GIBSON CO NT Y
l (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 terns of a qualified personal residence trust
INFORMATION
Nameof d7 1(kgal name), -
Social Security
Social Seo inty number of claimant's spouse (last five digits) Drivers license l Identification l Other number Issuing State
of claimant's spouse (last five dgds)'
CONTRACT ••r .
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY
Coun
Township
Taring d 'd (cn yK m , t
01 KI&
i'll
Pa number
fption Is theca party m question:
Real property ❑ Annua %assessed mobile home (IC 6-1.1 -7)
Ii of the residential sbudure or the Land not 61coedhg one (1) acre V immediately sunou ds that structure is used to produce ircame, describe the use and portion
of N pent' ut3zed to produce, income.
- o- aa- boa - %/• 2452 as
.. OWNED BY
County - Township County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Pddrew (number aM street city, state, and ZJPcode)
yS.B S 1G klct,.�, J �GGo
2 c
ASSESSOR USE ONLY TRUE TAX VALUE ASSESSED VALUE
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Nolwithstandirg any ofherpmvision, ft sum of the deductions pmvrdM M IC 6- 1.1 -12 to a mob& tp that is
$
not assessed as mat property or to a manufactured hoe that is not assessed as real property may not exceed
one.haff (112) of the assessed value of the mobile home or manufacornnd home.
Signature of AuditorDate
signed (rtcnfh, day, year)