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"'" CLAIM FOR HOMESTEAD PROPERTY TAX
4 _ � STANDARD / SUPPLEMENTAL DEDUCTION
S State Fortn 5473 (R72 / 6O9)
t` � PrescriEed by Ihe Department of Lo�l Govemment Friance
lNSTRUCTIONS: See reverse side for fding instructbns.
T �l
FORM YE�
1
�
I(We) ��l(,�Y/P1'�,OL. �] 1 l �C.[.ddY/7 \ certiry ihat I( � pied�,t�ur) prindpal
place of residence or am (are) buying the following described real property (or which a Homestead Property Tax S�an fl��ijction is by daimed
under irau on ihe date ihis applica6on is filed, (date o�filing): �
GIBSON COUNTY AUDITOR
I(We) own ❑ Am (are) buying under recorded wntract
❑ Am (are) entitled lo occupy as a tenant-stockholder o( a cooperalive housing corporation
� Have a beneficial interest in ihe Wst or the right to occupy the property under the terms of a qualified personal residence Wsi
Recpd number Pa9e
row�, rowrisn�p)
ihe property in Question:
1' '1 Uo(' U W•`I / l' U o! b I LJ �� wavero LI A^^��' assessed rtnhile Imme (IC 67. f-
portion of Ne revdentlal swcWfe or IAe IaM not ezrcetli� me (1) aae lhat Immediatey su�mu�WS Ihat strucNre is useA to produce i�nne, tlesrfiCe [he use and porton
P�PanY u9Taed tn P�ure inmme.
t.Ja�l.o�.cs���-n�.�.t� d 85p�'
Trnmship
I hereby certify the above ststements are we, cortec[ and complete.
Land
stare,
acre immediately I (��
�rovements.
Otherland
Tatal land (line 1 plus line �
Dwelling
Garege
Other Imp�vemenss
Total Impravements (line 0 Nrough line b�
Total value (Ilne 3 p/is line n
I herehy certi(y the above is true, cortect,
and complete.
Veifyug adion - Signature of �tw
(3)
14)
(5)
(6)
��)
18)
Sig�aW re of Assessor
Caunry
Sipnatme o_ f tlaimant
Mwy._�_.. �
20 _ pay 20 Lesser of 60% of the assessed value of 1he homestead or $45,000 I
Ab�x4tutaMUg eny other piovivon, Ne sum ol Ihe deduclions provitletl in IC 61.1-12 to a mobi/e home Nat is S
rot essesceE as reel plopeM w to a menulerturetl home fhef is rrof essessad as resl properry mey rot ermed
Township
Date signetl (monN,
Da1e signed (monN, day, yea�
Oate