Mobile Home_Allen p rye' AO' YEAR
f` ! CLAIM FOR HOMESTEAD PROPERTY TAX FORM
' :I CREDIT/STANDARD DEDUCTION HC10
'1/412s-
V.v. State Form 5473(RS/10-01) �r �
i
r°� Prescribed by the Department of Local Government Finance i ; , h
INSTRUCTIONS:See reverse side for filing instructions. t I q !�`
f ttli:V ; ?"` , *"� - -45 S...., L.GpRTIFICAMON STATEMENTZ4Vt `k*y ? -1r Y �3.0AU024 -1'
I(We) �.(�/ !/L(�' c/ ��c'w"c- �(X.l „ certify lhat,the 1st day of 7;{{'c'h 2�0T
I(We)occupied our principa pl of residence the following described real property for which a Homestead Pro Tax_Gfe4Whk y-a
❑ I(We)owned ❑ Are buying under contract GIBSON COUN TY AUDITOR
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Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
_ +' �t.;.�. .,�a�,�?iCONTRACT.;RECORDED .,e T'§iy:,r.'��aN!-'�'�=,�f?:a' .�. .' ;�'-"�"�r7i:If bon coSimple owner's name Rr's ofontract is recorded Record number IW age
`�' £-'.°ta:a+'--3��.�'t�-� e� .za.�.��m�°��'i�SS�"-�.:iPROPERT,Y�ESCRIPTIbN��.?�°•r,3x?�6:s�.>'S "��`,_:
. -61.,11 rr:,,Z'.Y�XA,±.1
Other improvements (6) iv I;h:;.x�,4 s-ts
rag,..T'�'3
Total improvements(line 4 through line 6) (7)
Trial value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete. qq\\(\
Verifying action-Signature of Auditor \ c j \ Date signed
Ir `ict--nr:ray3„ i '3ri z',a-*'n STANDARD:DEDU610N'ALLOWANCEa.s$',�• -";:.y� u i ':Voltre w. '' -`,`a', ,5
t� 20_Pay 20
\\ Lesser of 1/2 Homestead ' '
\ Val ation or$6,000 $
Signal a of itor ' 1 Date sjgned_ . a ,