Mobile Home_Miskell CLAIM FOR HOMESTEAD PROPERTY TAX
N. , FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions
E :r 0- '. t 9e't'•- . - 1•al-' -. A •T1FICATION STATEMENT." - .• - _
I(W ) 4 1 k illA�1i�� - - ce a n e 1st f e
I(We)o upt-• as our principal place of esidence the following described real property for which a Homeste Pra rty et•�r •*aimed:
I(We)owned ❑ Are buying under contract FEB 2 ((fi�rS,
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 1 er a contract.
�-w 5rigv4•: .f -.q ftf i- ':e>:.?'i-n_ -:r .res: ;-.. ' CONTRACT.RECORDED f„' .. • • 1.. o ` '6�•
If buying on contract,Fee Simple owner's name ' - GIBSON COUNTY A DITOR 4
Recorder's office where contract is recorded Record number Page
+t4=%a _.:c"-f.L1 'e_"y. _'r. F'`;c_'`. PROPERTY DESCRIPTION tET
County Township Taxing district(city,town,township)
. I.s.Q -
F` `.bar "y/ /V Legal �7 3 Y en S /,4/ ^� IS the property in question:
❑ Real property bile Homo(I.C.64.1-7)
If any pa ion of 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.
.3a;:. iV.»t . : ' '.' • PROPERTYAWNED$Y CLAIMANT.IN.OTHER"COUNTIESr- •e>' •+j- T7. ;wr : -:'('-'1'42.4 -
County Ta2,2 -county Township
I hereby certify the above statements are true,correct and complete. Signatur nt. ..�, nn i
Address(number and street,city,state,ZIP code) I, `r, W�
d e w Al of,-„1.--a tit O 4 )._
i' a+1i}+;�:'Z'`' ' - - • . TRUE TAX ASSESSED VALUE HOMESTEAD' - s NON,RESIDENTIALz
ts._,,;t•s c -ASSESSOR USE ONLY,. -
izie4'e...o-,, r.'b - t°-s>7, -. VALUE • AT 100%OF:17V • VALUE a VALUE
}Land not exceeding 1 (one)acre immediately --- It
surrounding residential improvements. (1) .z! ' ,
Other land (2)
Total land(line f plus line 2) (3)
Dwelling (4) ,
Residential improvements or Annually - 1` r• rr '-"
Assessed Mobile I Manufactured Home 1"�`as
Garage (6) - . . „_— ..
-
Other improvements (6)
Total improvements(line 4 through line 6) (7)
tl" /
Total value (line 3 plus line 7) (g U
I hereby certify the above is true,correct,and azure of Assessor Date signed
complete.
t I
Verifying action-Signature of Auditor "d In n Date signed .
k\)11 ib, \�\, \ I X1(0
®h"'`^ 24:41-.'. `'_- . t--=. `- .DEDUCTION ALLOWANCE---.: •- - -
` 20 Pay 20 --_ -
(. 4 Lesser of 1/2 Homestead S
vauauon or 535.000
•
Signature of Auditor - Date signed