Mobile Home_Brown jb ?� CLAIM FOR HOMESTEAD PROPERTY TAX FORM - YEAR
1';;� CREDIT/STANDARD DEDUCTION �
`p(�l`` HC10
State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. FILE f,j
S: s u_ b_"'r f4-.4)',iYS.�V- _-4! t t 4idara,.i CRT)FIC ATION STATEMENT_ l: _ : W,
'c FEB 2 8 2006
I(We) �,(,( ( 0 t L._VL4 r lL TJ certify that on the 1st day of March,20_
I(We)occupied as our pri pal place o residence the following described real property for which a Homestead Property3all Crecliesj lgby claimed:
❑ I(We)owned ❑ Are buying under contract l�'16°?Nr+V
GIBSON COUNTY AUDITOR
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.
s =, ` " N �Y���n*v viVWC O NTRACTR ECORD ED=re;�:.>a� �r`�a e3i � ?
ae rWad rtr4:kTli".0
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
Fs"'- "` .4.WAa ..igits2:_'x�'�5,.. tZr...A Sfia5•real., Te P,ROP.ERT.YDESCRIPTION :f„ -.:;r 35. rft-Nf.re.-' 1raitI5 :164:i5
County Township Taxing district(city,town,township)
um r u l al des ription Is the property in question:
1 g:� ❑ Real properly bile Homo(I.C.61.1-7)
If any portion of the resjdentlal structure or the land not exceeding one(I)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the proper�l�.(y/ 1To produce income.
' l�
S• ' .3s` ''':,N,Jt't. 't�{P?'fe.wrw{W iPPROP.ERTY.OWNED,BY CLAIMANT;IN;OTHER"COUNTIEBr'. � ``�"' •' 3"'.'.'
.m..i. .Nt + :.":3.ssre -' R'."-s'?3TI{ls,
County Township County Township
I hereby certify the above statements are true,correct and complete. S' ature of claim
4111 t(nurnperarxd_stree}.,fiasfaft/P code)
.S A S'SESS:2R.USE ONLY r i � { r RUETAXY ASSESSEDVUE HOMESTEADF N
ONSIDENTIAL '
x�. �F 'T t rsy ; zet �iy it VALUEyS _ A5100/ OFTVS atVALUE� w+rrVAUE jg
Land not exceeding I
(one)acre immediately ykyt OY(1) fi
surrounding residential improvements. vv n,. ;
Other land (2)
Taal land(line I plus line 2) (3)
Dwelling (4) -v q„S;.yy� ,sES
(Residential improvements or Annually 1112%,r°='""`�6 ^ " " `R ``�-
Assessed Mobile I Manufactured Home Garage (5) x%.:ti
Az4Fari::4,Other improvements (6) 1,-r,=. -'I
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (S)
1 I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
I Vim_y Fat„Zi Y,"f tor- j}-,TM r...,. -S. ..-, -1 r+ aa.
a ,:tirt;*�•n_��'�-�,. ,:STANDARD'.DEDUCTION'ALI:OWANCE, .�.,,:;�•;`�,�"�y;� ��r,� ., fr$':�i��l,4x^a*�:a
�/ 20 Pay 20 f� nnn
g Lesser of n o Homestead \ '^ S �\\l kit Lesser of n or Homestead 1 1-\� r� b
Signature of Auditor c , \d \ Date si
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