Mobile Home_Lofton �`--''• CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
' 1'l CREDIT/STANDARD DEDUCTION • I
f/ State Form 5473(R6/403) 11 ■-'t
ir. i
r: Prescribed by the Department of Local Government Finance f i.i_
NSTRUC71ONS:See reverse rids for Sig iubvotions.
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��� a� ,Y � �S §?» � � Lt� 7��CRFCl10NSTATEMENT x.• r 'hT�y j . �• .� x'r ; '_ �..a '.
I(We) # / / A d i certify that on ty141�yy,45 20_
I(We)occupied as our prim .l p ace of re -rice the following described real property for which a Homestead Property Tat Credit Is he "toned:
GIBSON COUNTY IQ
❑ I(We)owned II Are buying under contract
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.
dw� „'s • "t i'( f+T A -s x. .y{i l'cY ttil <ir =`1ic'cY`l _9
.r,Asvr;��_r��€.Fg, -`�:...srs� .'e`� _._ -.�-zCONTRACT:RECORDED.,,;-E;�, i?� :rr.,:S. �i. 3 .�-..�.'-._.�,rt-
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
s; "...'.` F"..;-eat$I �- -AWit0P.ERT.Y.DESCRIP IONefi "�'�'s.�'-_Kafir .Xit:, �'.._s,..-tr"°s .. � '`s'`�4t"efr i_
�z"i rte. ,��°-- _
County r Township Taxing t( ty,f `',to i r
Pa • AA Leger descri I' the property in question:
fe I —O q7_ / �/ .1 AFL ❑ Real property o bile Homo(LC.6-t 1-7)
any••Non of the residential structure or the land no exceeding one(1 acre that immediately surrounds that structure is used to pr uce inc orv2,describe the use and portion
of the property utilized to produce income.
:ST .,tr�,,.�,�$"R tt--.mz�..Y23k--•.,��3cEP.ROP.ERTYOWNED BYCLAIMANT:IN;OTHER'COUNTIES,.aeit•..-�-3s��a:?s�. ��=�?��a?�J�s'�`'i€
County Township County Township .
Signature of claimant -
1 hereby certify the above statements are true,correct and complete. I r --
y / n
efldresss(number and street, state,ZIP code) �p f ! V . •*ex 4i / L ie,ti cvl /� _
3 r A35 S50'Y U EON�y r•: 7RUETA1 ASSESSEDVALUE - HOtdESTEA0 •x ANON IESIDENTULL gq�;ra
x a 3.a+° e.'7€f. $ ' ;. '•X n^#'� ° .:' ,t VALUES"l.}..� *ATS100/e OPi�+TT.V, 8a` VALUE 3iVALU .'`,�
Land not exceeding 1 (one)acre immediately s M s
surrounding residential improvements. (1) . „d, r , r _ 14 3-
Other land (2) i '
Total land(line 1 plus line 2) (3)
r-x3' t9 x' .x £ .
Dwelling (4) io-` 'gd bc+m-
IResidential improvements or Annually g ( ) �' .
Assessed Mobile I Manufactured Kane Garage (5) eta -�a.. r'
. . t -, 1
Other improvements (6) '?Ir* 2 `
Total improvements(line 4 through line 6) (7)
Total value (line 3 p1w line 7) (8)
I hereby certify the above is true,correct,an Signature of Assessor Date signed
complete. I
Verifying action-Signature of Auditor \ \rb \\ \\h \/'\\\Q, Date signed
��_sF�,>x``��'a�.>- ^Wt•+�I�3�.;�.;ty�:'�`-3s°=.,s�-i#,�?L�.k;;STANDARD'.DEDUCTION ALLOWANCEr v,i-ra�k?3�:4t ''�n arm"'+;?s:�?�^� oe_-�i+.,.-a��1;�rn.=Rs
20 Pay 20
' \.\ Lesser of 112 Homestead $
V9ueeon or 535.000
Signature of Auditor Date signed