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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1216-09)
.� Prescribed by the Department of Local Government Fnance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC70
I (we) certify that I (we) occupied as my (our) principal
place of residence or a are) buying the Ilowing described real property for which a Homestead Property Tax hereby claimed
under tract on the date this application is filed, of filing):
(date VVii1��
(We) own E] Am (are) buying under recorded contract GIBSON COUNTY AUDITOR
Am (are) entitled to occupy as a tenant - stockholder of a cooperative housing corporation
Have a beneficial interest in the trust or the right to occupy the property under the terns of a qualified personal residence trust
INFORMATION,
Name of daimant (legal name)
Social Security
Name of claimant's spouse (legal name)
Social Security number of datmant's spouse (last five digds) Drivels license I Identificabon I Other number Issuing State.
Social
of claimant's spouse (last five digits)
CONTRACT ••r r
If buying on oontmM Fee Simple owners name '
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION
County Township
Taxing district (city, town, township) ..
Parce! numbenr Legal descipron
Is the property in question. C'
^
O[� V .00%
❑ Real property' 'r ❑ Annua ly assessed mobile home (IC ti-1. / -7)
If any portion of the residential suucru or the land not exceeding one (1) ace that immediately suno that�strlucture is used to produce income, describe the use and portion
/ands
of the property utilized to produce inceme. R IC 4l- I - 3 -q
"� SC P L im 1 Sri
f f I
T
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
County Township County .- Township
1 C
I hereby certify the above statements are true, correct and complete.
Signature of claimant
A(Vre5s (number and street, dry, state, and ZIP code i-
r • • r
x ) acre diatety
residential improvements. (1)
surrounding
cu >•gt,
Other land
(2)
*i'Y4�s� � c-
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
g
()
Assessed Mobile 1 Manufactured Home
Garage
Other improvement
Total Improvement (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying actor, - Signature of Auditor
Date signed (month, day. Year)
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
Notwifhstandirg my other provision, the sum of the deductions provided in IC 6.1.1 -12 to a mobile Lame that is
S
rot assessed as reel property or to a manufactured home that is not assessed as mal property may net exceed
- '-
one -half (1)2) of the assessed value of the mobile home or manufactured home.
Signawm of Auditor
Date signed (month. day. year)