Mobile Home_Willis (2) . . 1
g `'�' CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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CREDIT/STANDARD DEDUCTION HC10
State Form 5473(R6/4-03)
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Prescribed by the Department of Local Government Finance \J]�
iLED
INSTRUCTIONS:See reverse side for filing instnations. -
.aCti.,?-2>n CI:•;/.aa4 zi z>r...rgrt _' -344,`-_?CERTIFICATION STATEMENT-- iw .; a ��?"4r-a:77.-.;
• i �rJ I D ZDDi _
I(We) ///c5 certify that on the 1st day of March,20
I e)occupied as our prin 'place of residence the following described real property for which a Homestead PropertyvTa Q(editg,Ogby claimed:
I(We)owned Ele buying under contract 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.
t e'.Y .S' '` V h`nice+3vrennAtc.11MCONTRACTIRECORDED"atiWtt4c5U-`T`" 4:4:i.q .eTOTe..*''.ass..: -i:.
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
s�.rr. "2-g.t"nma g:.W.� :Wr^,� :FRO PER_TY:D_ESCRIPTION v_..� : Y zr � �J_ Jtkv
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County
Township Taen istnct ty,town owns/up) D
Per .�e�A,�..-r f�-� t j��1 Legal s pGon (J� Is the Property in question:
\�/%%J — 1 (J /� � �Q ❑ Real property Mobile Homo(/.C.6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1 that immediately surrounds that structure is used to prod income,describe the use and portion
of the properly utilized to produce income.
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T._r_. ,ia.way�e-srerniPROP.ERTY OWNEb:BY CI''AIMANT.INOTHER'COUNTIES eZia'a?te �xi��33�s"�-- -T,�`''`+`.'4zW"i
County Township County Township
I hereby certify the above statements are true,correct and complete. SC( claimant
Lida 67gtO
dress(number end street,city,state,ZIP code)
4
'W-14 1It ig4'" riti RUE TAX >a ASSESSED VALUE W HOMESTEPb �k -_
y ASSESSOR�USE ONLY -•'' i..ss NEN-,RESIDNTIALt
�'::�'a4. :3C6 y:u%Pk1:: "_^: . •.-ti� , zza,•VALUEgFhi y ' _AT1005 OFyTTVA s fALUE .i:Y- .ae.VALU HEC O
Land not exceeding 1 (one)acre immediately '•� a;•`"'.,"x'?yi'.!* x"J
surrounding residential improvements. (1) t!,-��£�?`
Other land (2) „ 1
Total land(line I plus line 2) (3)
Dwelling (4) - Wki 4711.
(Residential improvements or Annually
Home
T 7 1 % w4
Assessed Mobile/Manufactured Home Garage y,1
ci
r,44Other improvements (6) - "'
Hz f'tua:.,.sL
Tctal improvements(line 4 through line 6) (7)
Total value (line 3 plts line 7) (g)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Aiditor Date signed
• ,�Tw'%kt.isT- 1A"--* ` `STANDARDDEDUCTION ALLOVVANCE t- - ' -T'' "' ' r ..• t
��\ 20_Pay 20 ()
r� Lesser of 1/2 Homestead In-lbn ''h\�\�( \`\(1\ `\{D
0` valuation or S35.000 \ \d' \ \ C,\\ 1 \
Signature of Auditor \\ \ Date signed