HomeMy WebLinkAboutHomestead_Beasley (2)CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
- � Slate Form 5473 (R73 H2-09)
� yw J Presaibed 6y the Departmant o( Lacal Govemment Finance
INSTRUCTIONS: See raverse side for filing instnictlons.
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1(We) � certiry that 1(�Pe)iiccvpiefl�s i
place of resldence or a re) buying the following de real property for which a Homestead Properry Tax Standard DeducUOn i.
�er contract on the date this application is filed, (date o�filing). I(VJe): GIBSON COUNTY A
Own ❑ Am (are) 6uying under reco,ded contract
� Am (ara) enGtled to occupy as a tenant-stockholder of a woperative housing corporalion
❑ Hava a beneficial interest in the Vust or the right to occupy the property under the terms of a qualified personal residence Wst
❑ Am (are) Ne shareholder, partner or member of the entity that owns �he property.
Name d daimant (rega� neme)
sh.
Sotie� Seaaity nmiher d Ua'unant (kstlrte di,
� �
Name of daimanfs spouse (�gal name
Sodal Securiry num6m o( daiman['s spouse
It
contrad, Fee Simple ownefs `ume
convaa is remraed
��
Paicel number
e��,�,����,
Drive/s licensa / Identifiration / Other numbar
ot daimanYs spouse (lastlrve dgrfs)
p_Rj_i!i
IS
�f a�ry portion oi dce asidenUa� swaure or the �arW not exceedi� ane (1) acre tnat immediatelY wmwmas iha
d Me P�PanY utiGZed b protluce Incama.
� a�-��-z y_ z� Z-000 ai 9
Township
I hereby certiry the above statements are Vue, cortect and compiete.
AdO�ess (numDer entl stree4
� � �h L . ��
land not exceeding t(oire) aere Immedlatey
Other land
Totel land (fine f plus lirre �
ResidenUal improvements orMnuafly �tiing
F�sseased Mobile I Manufachrted Hame Garage
Other Improvements
Totel improvemer� (line 1 Mrough line �
Total value (line 3 pl/s llne 7)
I hereby certify the above is trve, corre�t,
Verifyvig aGbn - Si9raGire oflwtlitur
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(3)
(4)
(5)
(8)
SlgnaLna W Assessor
Issuing
Retord number
prindpal
0
Page
18f1y in Guestidl:
al propgty � AnnuaOy essessetl mob0e hortre (IC G7.1-:
s6u�iure is used m pmduce mmne, tlesaihe the use arb pottion
�' _ _
�'TIESi�I; `�:'ri:t3-°�:�;•,.�•'�'',
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20 _ pay 20 _ Lesser of 60% of the essessed value of the homestead or $45,000
No�viMSfeMirg any otherprovision, tAe sum of Ne detlucfiorts provMetl ln IC 6/.1-12 ro a lmW7e Mme fhat is $
not assessed as ieel pmperty w to e manulactured home Net k rat assessed es 2al property mey rof exceed
nnw.hnHlf?I Nthe new< �.+�gh�g dfhe moWle hOrtlBWmenlAdclured h0/nB.
Date signed (rtronN. daY• 1'�A
Qate sigrre0 (rtanth, daY• Y'��
signewre ot a,aw, I oare signed (mon�n, aar re�