Homestead_Callis (2)�
"'" CLAIM FOR HOMESTEAD PROPERTY TAX� �
, STANDARD / SUPPLEMENTAL DEDUCTION
i�r ~ State Fortn 5473 (R72 / 6-09)
�O � Presmbed by Ihe DepaMcenl W Local Govemmem Fra�e
lNS7RUCTIONS: See raverse sitle !or filing instnictions.
FORM Y�
10
��
i M'e� �,�/.J�p�n m Cj l A 1LCln ceruty u,ai i�we) om,� �y (our) prindpal
place of residence or am (afe) buying the foliowing described real property for which a Homestead Property Tax Standard DeduUio�r1 �rmh y daimed
under conVaG on ihe date this applicatlon is filed, (date o/filing): GIBSON COUNTY Au TOK
�e) own ❑ Am (are) buyi`g under recorded conVaa
❑ Am (are) enEtled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interest in the Wst or ihe right to occupy [he property under the tertns of a qualified personal residence Wst
nama o� oammm �rega� nama� /
-, �enn
soda� seauiry rxurm d daQrem (
Sorial Scauib number oi dalmanYS aGa� (lasl five
tl buymg am m�tract, Fre Simple ownels rame
RecoNefs offirc where mnUad is recorded
���y Townst
PartrJ numbar Legai d
a //r
«���� ��u
Orivels Gcense I IdentifraUOn I Other number
ot claimanTS spouse (las! frve dlgitsJ
11 arry partion d Na residential sNicWre n Ne Ia�W not ezcead4g one (1) ac
� ot ihe Pmperty wTaeG tn pmCUCe mmrtre.
a�-� 9- l 8 ,3�� �
�
Caunry
Township
I hereby certify the above ststements are We, cortect arM complete.
(number and shee4 � stete.
Land
Otherland
7otal Wnd (line 1 plus line 1)
Immediatety
nents. ��)
�z)
(3)
Residential improvements or Annually �����9
0.tsessed Mobik / Manufactured Hartro Garage
Other Improvements
Todl improvemenb (Ilne I througA line 6)
Total value (llne 3 phs line 7)
I hereby certify ihe above is We, cortec[,
and wmplete.
Veifying actim - S9raWre o(N�dtur
(4)
(5)
(6)
Iswi`g
lown,
number � Page
,! ,.. Is �he pmperty in Question:
<
✓ ❑ Real poperty ❑ MnuaOy assessed rtwd'le hane (IC &t. f-7)
hat 4nmediately surtounds thal sWCWre is used m produce Incane, desaibe ihe use arM portion
°�a-°a �
Counry
o�
20 _ pay 20 Lesser of 60% of the assessed value of Ne homestead or 545,000
NoMiNSferdmg eny oNerprovision, Ne sum W the dedc'l'wu provided in IC frf. f-72 ro a rtab0e f,ome Nat is
not essassed es ieal propeny w lo e menufectured hwna that ls rq( assessed as reel property may riot exraed
arreJ,sH/121 W fhe assested valueW the mo6➢e hm�e or mvnNactured hdne.
S
yee�
D2�e signeC (rtronN, tlaY.1Ta�)
pf qWttpr � Data signetl (monlh, tlay, yea�