Homestead_Hedgesg,..'". A CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTAL DEDUCTION
State Fortn 5473 (R72 / 6-09)
°` � Preunbetl by the Oepartmenl of Local Gavemmenl Fi�nce
INSTRUCTIONS: See reverse side for fJing instrucfions.
FORM
HC10
�
YEAR
I(We) � �� n-' Nat I,(�w�� p� astm1I�(our) prificipai
place of residence or am are) buying e follovnng descri real property for which a Homestead P perty Tax St untlar�ductiori'�5 hereby daimed
under mnVact on ihe date Nis applicatlon is filed, (date of filing): �y�
❑ I(We) own ❑ Am (are) buying under recorded conVact Q�!6 ���-°
❑ Am (are) enlitled to occupy as a tenant-srockholder of a cooperative housing corporation �/ '�
GIBSON CQUNTY AUDI7(j�
� Have a beneficial interest in �he Wst or the right [o occupy �he property under the tertns of a quaiified personal residence Wst
Drivers ficenve / IdenUfication
of tla'imant (WSf (IVe digifs)
(lasf five digds) Ommfs tirense I Itlentification / ONe
of daimani's spouse (Wst frve d"gds)
It buying om m�tract Fee Simple owne�s iume
RetoMefs of&P where contrad is
Courrty
Tawnship
EescriDtion
or the Wrd not esreeding orre (1) ace Nat immediatery
Twmship
1 hereby ceNy the above statemenis are We, covect and complete.
Land not ecceedi'g t(one) acre immediauty
surtounding residential improvements.
Otherland
Total land (Ilne 1 plus line 2)
Residential improvementa or Annuaity �����g
Assessed Mohile / ManufactureA Home Garege
Other improvements
Total improvements (line I Nrough ltne �
Topl vatue (Ilne 3 pl,s line �
I hereby certify ihe above is true, cortect,
and complete.
Vairyvu7 acfion - Sigrtayre o( /wdtw
��)
(2)
(3)
(4)
(5)
(6)
(8)
SgruNre of Assessor
distria (cif1:
Caunry
I55uY19
Rcowd number � Page
Is Ne p erty in question:
�al pmperty ❑ AnnuaOy assessed mo6ile home (IC G7.1-
u Ihat swcwre's used tn protlure 4�mne, desmba the use arN pwtion
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
MWwiNStaMing anY olhe� pmvision. Ne sum W Ne tletluctions p�o�irled in IC &f. f-f 2 ro a moEde home Naf is
rot ass as ieal properry or to a menufaUUred home lhat is rot assessed es real pmperty msY rwt exceed
onsh� W Ne assessedvelue oJ Ne mobie Mma or manulaCU2d hM�e. _
3
Taxnship
signed (monN, day, yea�
Da1e signed (rtanN. OaY. Y��
Daie �gr�(rrionM.
� �� � �