Mobile Home_Robling I
itzT>y.t
`t) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR _
"= CREDIT/STANDARD DEDUCTION 0
4;� State Form 5473(R6/4-03) I_ j !
Prescribed by the Department of Local Government Finance 1 1 I r
,
INSTRUCTIONS:See reverse side for Kling instructions.
a'''{`.=a--1.-?s:� z. _>, riv1 -e:F'_J%r a .Ti+=-7sa. OERT1F.IC,• ON STATEMENT - - .T,Fc."9 .i42Uu. .. .. :
I(We) . /f/�'/ A I �-/. t� _ certify that on thnet4lay ail',20
I(We)occupied as our prin• p:l pl.. - of residence the ff•ng died real property for which a Homestead Property Tax Cret is hereby claimed:
❑ I(We)owned 1 Are buying under contrac GIBSON COUNTY AUDITOR
ADHave 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.
a. Y:�:3t4eN�Xi}�`^'ST��`�'3 ,✓S..'-'Fcx-`w'J' Y,#n�.'�-r� d£„i_;� �[ � Y
._.- � � � � -CONTRACT-!RECORDED�. .�:-�`� .-`A�t�:.'r��. � n^r.�.,�2�=,.`•' ��x-_.:
If buying on contract,Fee Simple ownees name
Recordees office where contract is recorded Record number Page
` - 7 ..., hr 'r tatYie,arig Z=RROP•ERTY:OESCRIPTIO ' g r" t 4 1rrgif ry s 4;.ror
County / Township Taring distri ty,fo fownshj6��
( /ter 11��((// ad,
Payy:• -r d /1 L al[/q ,/I,IJQn1/ Is the Property in Question: `�-,{/
tier /"9/ CO / `� \ � U/f ❑ Real property Ii51 Mobile Homo(LC.6-1.1-7)
I any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to pr co income,describe the use and portion
of the property utilized to produce income.
T u
• S � aMEktaP.ROP.ERTY.OWNED'Bl'CLAIMANT;IN:OTHER'CO(1NTIES`�`�.�-t-C2`7 ->` -7e `3" 'r.
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
ress(number and street,city state,ZIP code)
ae idSSE `ORSE NiYa rc� `TRUETA.. ASSESSEDVALUE VAtiiELST thi n N' ESIDENTAL Q
u -at . u _:ar-F Pdc ^- Y. J;4� 3 i' %VALUE..z� _'AT-_100WOTTV VAUE.t Pt £ A LUR c W.
Land not exceeding 1 (one)acre immediately weir: + �;g-„
surrounding residential improvements. (1) Fp1 "`
Other land (2) �-6Lig..
e -'�x='aFi1'`�
Total land(line 1 plus line 2) (3)
'ri TS28Y ,♦ r c
Dwelling (4) 'eE' .,,.s"�' 3 �.
(Residential improvements or Annually -''.1T.ritt . , • tea'`-it'
Assessed Mobile/Manufactured Home Garage (5) y• v.w -7-;.a" -
c
Other improvements (6) 'cfrity l
Trial improvements(line 4 through line 6) (7)
Tctal value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
' 1. -i,``.'.frje.: "?k `'C' trr->'�58 :a STANDARD;DEDUCTION'ALCOWANCE*• f•:i,irk:esa° ' ..±:-7:i+_+`sz ..tl.c'''a a.'
20 Pay 20 f� `I
Lesser of 1t2 Homestead ;�,l' ''1 K (1 1 Q
'�� valuation or S35.000 \ \� \ \` •\ • •\ -
Signature of Auditor - Date signed