HomeMy WebLinkAboutHomestead_Whitehead�`"'" CLAIM FOR HOMESTEAD PROPERTY TAX
�s', ._,_ � STANDARD / SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 609)
�� •� Prescribed by Ihe Depanment of Local Gwemmeni Fnance
lNSTRUCTIONS' See mvnrte sidn fnr fi/im inslmNinns
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�(We) ceriify ihat I(we) /�/d as my pnndpal
place of residence or am (are) buying e Ilowing described real property for which a Homestead Property Tax Sfandard Do��CI�� ��aimed
under conuaa on the date this app�ica is e�ed, (date of 6I1ng): GIBSON COUNTY AUDITOR
❑ I(We) own ❑ Am (are) buying under recorded conUact
❑ Am (are) entitled to occupy as a tenant-slockholder of a coopere[ive housing corpora[ion
� Have a beneficial interest in �he Ws� or Ihe righ� to occupy Ihe pmperty under ihe terms o( a qualified pereonal residence Wst
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Name of tl2� ni al n3me)
Sodal Seamty Orivefs frPnse / Itlentifi�ation I
T� 1
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Name o( daimanYs spouse Qepal name)
Sotial Securiry numbar of daimanfs spouse (WSt frva tlig'rts) Onvefs license / Wentifiration I Other number Issu'vg State
ot dairtranYs spousa pasl frve dlgits)
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11 Giying on cnnvact, Fee Simple owneYS �ume
Remidefs ofice where cmiract is remNed RepprE number Page
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Counry Tovmship Ta�dng disiria (�, ip
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nu rn �/�� L?�/�al /de�stt'�ipfion I5 Ne propertyin questian:
�O f(,(�' I.O ✓�(.CY l ❑ Real Om7ertY ❑ Annua�y ass�ssr� ' e e(IC 6f.1-7)
�11 any portbn ot tha resMential sWCW�e or Ne WM not ezceeding arre (1) aQe that immedlatey sufmunds ihat swcNre is useA to produce inoortie. desaiCe the use antl poroon
of Ne propeny utif¢ed m proCUCe inmme.
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Caunry Trnmship Caunry Tmnn4dp
I hereby certify the above statemenis are we, cortecl and complete. �� ot t , �
ACdress (number antl stree4 cif): sfIDte, and ZlPCOtle) -
3a 5 � c v 17G3�
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Land not exceeding 1(one) acre immediately k�{�� �^"'v=E% '�"s"� "$�� '.-
surtoundin residen4alim rovements. (�) �--% �--T�'��� '��-��
i�"�' � zY
Other land (2) -a; a;�i::.�.y,K`.`; �
Total land (line 1 plus line 2) (3)
'3i'�is� W � �:. c,. l � �r
ResidentialimprovementaorMnualty �elling (4) '�< f+���,�'�,�5v�y� . �,,,�
Ass�setl Mobile 1 Manufacturetl Home '" k-^��S��E'x�'� 't -c ��.,=:` �
Gara e ,�. -'•u>` . w N_s ,r � .
9 (5) : i�,....c .� :m'Pt ,�r?':. U.E�'i.s?
4`:
Other improvemenb (6) ��`{.:v �'�k;'?�'�'�
..- ns u"..� 7.
7otal improvements (Ilne I Nrough line � (7)
Total value (line J p!(s line 7) (8)
I hereby certity the above is [rue, corted, Sigrawfa of Pssessor Data signed (monN, day, year)
and complete.
Vai/yin9 action - Signawre of Niditor Date signe0 (rtronlh. tlay, yea�
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20 _ pay 20 Lesser of 60% ot Ihe assessed value of �he homestead or $45,000
AbrtailhslaMing anY otherpmvision. Ne sum o(Me detlucfions provided in IC 61.1-72 fo a mo6de fame Naf is g
rwi ass as iaal properry w fo a manufertured home fhat ic rot assessed as leal P�PaM �y �t ezceed
m /) o! Na a /ue / e mobde fama or manu7aduied home. tp-Cd
gg � Date �( ! V /