HomeMy WebLinkAboutHomestead_Wilson (8)- '" CLAIM FOR HOMESTEAD PROPERTY TAX
�; STANDARD / SUPPLEMENTAL DEDUCTION
Sr State Fortn 5473 (R72 / 6-09)
�' 1 Presrnbetl by �ha Departmenl of Lool Govemment Finance
INSTRUCTIONS: See �everse side /orfiling instruclions.
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I(We) //..1 UN certi ihatl
fy pied as my (our) prindpal
place of res' e or am (are) buying the follovring desaibed real property for whirh a Homestead Property Tax Sta a �a�iRs�ereby daimed
�und r mn on ihe date this appliplion is filed, (date of fililg): GIBSON COUNTY q(/j8�fi(�R
I (We) own ❑ Am (are) buying under remrded contract
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperative housing wrporation
� Have a beneFicial interest in lhe Wst or Ihe right to occupy the pmperty under the tertns o( a qualified personal residence Wst �
If buying om m�traq Fce Simple ovmefs �me
RemNefs of&r where mnvaq is recoNed
Caunry
of daimant (WS( �rve d'giLS)
DriveYS license I Identifiwtlon / ONer number
of daimanl's spouse (Wst five dgifs)
(crty, town, townshrP)
155uing StaN
RemrE number � Page
Paael number L ptl n Is Ihe roperty in puestim:
' �� /� � 3 � /� Real GroVenY ❑ Mnua%assessed mo6ile home (IC &f.f-:
If a�ry portian of the resdentlal swcvre w the larid nol exr�eding me (1) ace Nat immeE ;tety syrtqu�ihat sWrlure is used to p�otluce iMOrne, desmibe the use aM portion
loi me ProPenY uui¢ee b PmOUCe income. �p �[
o��-ig_��-3��a� ��a-aa�
��
Tawnship
1 hereby certify the above stetements are we, correct and complete.
Laoe
Otherland
antl s7�eeC riry, state, altl
acre (mmediatety
7otal lantl (line 1 plus line �
Residential improvements or Mnualty �elling
ASS�sed Mohile / Manufac[uretl Home Garsge
Other improvements
Totai Improvements (/ine 0 thraugh line 6)
ToGi value (line J p/`s Iine 7)
I hereby certify the above is true, cortect,
and complete.
/ailyi�g acGon - Signawre of Auditw
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�2)
(3)
(4)
(5)
(6)
(8)
Counry
WA�NU � lSt�. , 7T� rc7 A/VCh
20 pay 20 Lesser ot 60 b ot Ne assessed value of the homestead or $45,000
Ablwif�SfaMirg any atherprovision, Ihe sum of Ne deductions proeitled in IC G7.7-f2 ro a rtro6i7e frome that is
rpt assessed es real property or fo a msnufeUUiad home Nat is nof essessed as ieal praperry msY no( erceed
one-haHl121 alNe assessetl rdlue a/ Ihe mobde home or manu/aUUretl homc.
SignaWre otAUtlitn
S
TownsNp
:Y, 5'76 SF8'
Date s9� (monN, daY. Y�
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