Homestead_Wheeler (4)CJ
CLAIM FOR HOMESTEAD PROPERTY TAX
� ._ s STANDARD / SUPPLEMENTAL DEDUCTION
State Porm 5473 (R72 / 609)
�� ,, ` Prescnbed by Ne Departmerrt ol Local Govemment France
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INSTRUCi10NS: See reverse side far filing instn�ttions. T�
I (we) I W
place of residence or am (are) buying the tollowi scribed
under conVact on the date this applicalion is filed,
❑ I(We) own ❑ Am (are) buying under
❑ Am (are) entltled to ocwpy as a tenant-stockholder of
� Have a beneficial interest in the wst or the right to occu
ortlaimam
Name ot
SaUal Senrtiry numbr of daimanYS spouse
W
I� buying om m�traq, Fee Slmple owners fwne
RecoNers o(fice where mntract is remrGeO
Counry n � Township
FORM YE'�
�� ��e,,��
� �`�"'.� _ ......�
' �' certiry that I(we)�cupL^� a; (our) prindpal
real property for which a Homestead Property Tax Standaiduev f(�t i.�reby daimed
' (dateo(�ling): V
GIBSON COUNTY AUDITOR
pl . if a q�fied ona�iden� �
I �� �. I
` . � ,����a �
�
I I
Taung distrid (rity, town,
Issuing Slste
Reconlnumber �Page
�."��=%� 3aao3�od`�e�� oa� �s���.�q��,� �- D
� ❑ Rnal pmperty ❑ MnuaOy assesu0 rtndle Mme (IC 67.1-7)
II any portion W Ne rPSiAentlal sWGUre or ihe IarM not exreetltrp7 me (1) aae Nat immediatey surtounds that swmre is used to pmduce inoome, Oescribe the use and ponion
o� ma wopem wr�m m�a�� mm�„e.
��Q��`
Counry
Townsl�ip
I hereby ceAify Ne above ststemenis are We, corteG and complete.
Pddress (num6er aM street, ary, s(ate, aM LPtode)
� �i�i9'� /o �S/,v
LanE not ezceeding 1(one) acre immediately
ONer lantl
Total lantl (line 1 plus line 2)
ReslCentiallmprovementsorMnually �����9
Assessed Mobile I Manufacwretl Home Garege
Other ImprovemeMs
Toql Improvemen6 (line I Nrough fine �
7oql value (line 3 plia line �
I hereby certify ihe above is We, cortect,
and wmplete. �
Veiry'vg action - Signay2 of Audibr
�Z)
i3)
I<)
(5)
(6)
n)
(8)
SlgriaNre a( Asseswr
Counry
3
20 ' pay ZO _ Lesser of 60% of the assessed value of 1he homestead or $45.W0
MofwilhslarMing eny NherP���. �e �+ a�e deticvfions providetl in IC &1. f-72 to a mo6�e Mme Net k S
rrot assesseC es real properry a lo a rtunuFaWied hwne Nat is rrof essessed es reel properry mey not exceed
oriY4aN//21 d fhe assessetl velue af N! mobie home w manulactured fqrt�e.
To�,�wv
Date signed (rtronlh. daY Y��l