Mobile Home_Young rlbs: CLAIM FOR HOMESTEAD PROPERTY TAX (J FORM Whit
r- CREDIT/STANDARD DEDUCTION 3 _ HCIO
�� Sate Form 5473(R7/5 i
P esubed by the Department of Loral Government France
j
INSTRUCTIONS:See reverse side for filing instructions. '
-- CERTIFICATION STATEMENT :J F C_ 0 5 2006 '
I(We) certify that on the 1st day of M�arr31.20
I(We)occupied as our principal place of resid „e the follow-I es&bed re-21 property for which a Hornsstead Prop -te•1Tgreby claimed:
Al(We)owned El Are 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
. • : - CGNTRACT RECCn"'UED-k: .. . .
If buying on mmact Fee Simple owner's name
Recorders office where cormact is /4:7 7 ^n_ _ Rend number Page
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- ' : ... • , • • • t :x.:`-.'-':'• 'PROPERTY DESCRIPTION.:.. - � :`• ' .. •- ..1 ';''.-.. : .••;•
County . .Towsbip Tang district(c y,town.township),
Pa/r�Gjd 'j �7 !', Legal //,Q- / / j the property in question:
3 O &b /- 0 �GGC�,to,( /�JG7 I ❑Real property I,•�•Q. le Home(LC.6-1./-7)
if any portion of the residential structure a the lad not one(1)atse that immediately mounds that structure is used In ,describe the use and portion
of the property utilized to produce income.
0)7 jAo %/?,9 V-60 77� -
al.P - Qa - Ili - \ \ o -103 . a1Q1 - oC1
-- ;. '"n 'PRODEIM,OWNED':er CLAMANT Di OTHER COUNTIs,:. ' . '. , d 1r": ..: .. -
County _ Township 'County Township. :: ,,,,,,on,
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I hereby certify the above statements are bue,cared m and rplete. 4
>>rnra(number and street thy state.ZIP Lode)
. rACSPeS Inc ONLY . ;• .e Yc 'J r TRUE.TAX ;.c ASSESSED VALUE HOMESTEAD- `. • 'ANON-RESIDENTIAL a
k 4r VALUE .4AT100%OF.TTV :;.,VALUE ; VALUE
Land not exceedrg 1 (ate)acre immediately 1 i . /starotmdrg residential improvements. (1) as.>,c.,�,.,'[_.. . . :•.x•.,
7
Other land (2) .a
Trial land(Pale 1 plus fine 2) (3)
Dwelling (4)
Residential improvements or Annually - 19. - ..• .
71,4
Assessed Mobile/Manufactured Home Garage I ▪t �twt•
Oder improvements (es) n _ _,�
Trial improvements(foe 4 WIT-0 Foe R) i _ _._
__I _—� _—____ _� ._.___—_ I —.
Trial value (fine 3 pits line 7) I(8) ---- i I � --
-_._r__—___—__A i
I hereby certify the above is hue,correct.and (Sieabxe of Msesaw I Dale Wined
fie.
Verifying action-Signame of Auditor I Date ton.---1
i _ -. . -. -:{,_YI/WDAR.2 f]'-:,G(•RWI:!'J.C)1NlyCC_ .. -. •. c '.- ____i
20 Pay on_ \
Lesser of 12 Hom r�d esr ��J( ( I ,
Valuation or S35.000 V A \ \� I S
Signature of Audi Date signed