Homestead_Yockey"'" CLAIM FOR HOMESTEAD PROPERTY TAX
_ � STANDARD / SUPPLEMENTAL DEDUCTION
i State Fortn 5473 (R72 / 6-09)
�� � Prewibed by Ne Deparimenl M Lmal Govartmerrt Fnence
INSTRUCTIONS: See raverse side for filing insWClions.
FORM YEAR
HC70
�ILEI�
� � M'e) certiry that I(we) occupied as my (our) prindpal
place of residen or a(are) buying the following de 'bed real prope r which a Ho s d Pmperty Tax St�nd�nfV�wa'-�S hereby daimed
under mntract on ihe date this appiiption is filetl, (date o7 lin : v
❑ I(We) own ❑ Am (are) buying under recorded contrect GIBSON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant-stockholder ot a cooperative housing corpora6on .
� Have a beneficial interest in ihe Wsl or the right to occupy the property under [he terms of a qualified personal residence Wst
•- • •
, Name of eg 1 �
Socal5avrily
Nama o( tla' t's s e(ley7a/ me)
Social
• •'� �
11 buying rn contracf, Fee Simple rnmefs name � •
Retordets of&c where mntrar� is reco�ded Reodd numbel Page
. . � • - � • •
ToMnship Tamg OiStriU( '.t to ip
arceJnumher /jW_CXIO.CI� �P�Ptiai IsNe pertyinquesibn:
J Woperty ❑ MnuaAy mod'le home (IC 61.1-7)
11 any portion W Ihe `asidential sVUCWre n Iha WM not exceed4g are (1) ava Ihat immedlatety surtoun Nat sUVCtura Is usetl 10 p'o0uce incdne, desaf6e the use an0 portion
� ol ihe PmPanY utif¢ea to P�uce mmnie.
• � • � � : • •
Counry Township Counry 7wmship
I hereby certify the above statements are we, cortea and complete. Sqgadre oi �
Pddrew (rwmbe� antl atrce4 �+N. slete, arN IP code)
I ��n s.�-ov., � wPiYtS�+ ��e il/ � Le�i�— 9Z � I
,. , . . .. . ,
�� .. '
l.and not exceeding t(orre) acre immeeiatety `�`e+= +� %..��'�:� ��"' c..
sunoundin residentialim rovements. (�) 3`����'�`'S°'S^� q'�f-.-,�,Y'�S�c;,'.
Y
ONer land � (2) '�� ` `�C���.�j��'
�Y��� .Si�F:
Tatal land (fine 1 plus line � (3) •
Dweiling (4) =*�.`d�'�''' n.�.�,"��.��,K�y,�"�_` �..
ReslCenUallmprovementsorMnualty =� "�+5�"5:§€�"'�x'3'��-"s.'=�
Assessed Mobile I Manufacwretl Home Garege 5 '_.-�.c�'��p.'� li� #-a,r,F�,'Fxyi'{£[�+�«w`,
� J `Y.1 RM., u:..-!'�..?St��KVVi�^:'.'.'�r°i
'-.Y'� 'SSF�,%s "'�.
Other imDrovemems � (6) :�k;(�;°-.";{i� .
>,,... ... . ..
Tofal improvementa (Ilne e Nrough Ilne 6] (7)
Total valua (/Ine 3 pl�s line � ($) .
I hereby tertify ihe above is [rue, cortect, Sp7nawre of Assessor Date sgned (rtronfh, tlay, year)
and complete. .
Vei�Y�+9 action - S5�cu2 of hMitor Date siB�M (monN. EaY. Y��
� � • • . � � � �
20 pay 20 _ Lesser o( 60% of Ihe assessed value of Ne homestead or $45,000
NdwiUwaMing eny ofherprovision, Na sum o1 the detlucf.uns pro�ided in IC 67.7-12 to a moDAe Irome fhaf fs $ •
not asseaed as real property a to a mawlaaured harrie that'a no1 assessed as real P�PaM maY rot eiceed -
o tl 7 e essessed vefue dfhe mobie home ar manNacture0 F�ome.
SI na re � � Dafe signe0 day
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