Mobile Home_Meadows CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
% e State Form 5473(R614-03) - -
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for riling instructions
e..cG" i .., -. -` Tom._ _ .'.: 't-'1:—. .` +_"I - . CERTIFICATION STATEMENT"
Y \',-�\ FEB 2 5 2005 �
I(We) 1 ` certify that on the 1st day of March,20
I(We)occupied as our pri ipal place of residence the following described real property for which a Homestead P ' is hereby claimed:
-❑ I(We)owned ❑ Are buying under contract GIBSON COUNT TTn
' Have a beneficial interest in the entity that is liable for the property taxes on the properly and that owns the property or is buyingulX W a contract.
OD��`rTElltlt-Vgrac tp.",i ---'A,...._:a .r,':al',-,, CONTRACTrRECORDED - - ;_.
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
. .r<� »v .=4.q ."r::_-.. .i -i-t. ✓ ,..--- PROPERTY DESCRIPTION`.%' . :r •
County Township Tracing district(city,town,township)
.4
i->,±:i
a cel num. _ Legal es tionvT Is the property in question:
4 a a 3 1 ❑ Real property ❑ Mobile Homo(I.C.6-1.1-7)
If any portion o=f the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
"itt fir. -
-Yte :'��;' �.:-. ?%�,ew.�-?�� � �;' 'PROPERTY.OWNEDBY CLAIMANT 94 `''�" '� r-`��+� = -i-"`< ''"�
County Township County Tow•r(Shj
I hereby certify the above statements are true,correct and complete. Sin imam � {�� �TJ
•
b o �/ l a� ' I Oct Lax
Address(number and street,city Blare,ZIP c `
v.g fi;F}X roe';`� : - 4 TRUE TAX ASSESSED VALUE - HO MESTEAD ' NON RESIDENTIAL„
,y.; A„w ASSESSOR USE ONLY_-. - VALUE . AT 100%"OF-TTV _- VALUE ' '. =i,.VALUE:- -
.
Land not exceeding 1 (one)acre immediately ','`?`= ``" --
surrounding residential improvements. (1) .. . -
Other land (2) - • . - --
Total land(line 1 plus line 2) (3) —
Dwelling (4) `, -- •.._ .�
Residential improvements or Annually
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Total improvements(line 4 through line 6) I (7)
Total value (line 3 pits line 7) (6) I
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor r I \�\\� `` � Date signed
yC`
.a;:.it'`"-. r :_�;` " �- -� - " STAN ARO.DE000TION ALLOWANCE"-• �" " ' " � =
\ 20 Pay 20
V� Lesser of 1/2 Homestead S -
jvacation or$35.000 n �\
Signature of Auditor El � � 61� !p®
F-LB 2 5 2005