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°' CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
` State Form 5673 (R8l 7-07)
�` Prescnbed by Ihe Department of Lxal Govemment Finance
INSTRUCTIONS: See reverse side Por filing ins6uc6ons.
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I(We) oocupied as our prindpal place of residence the fWbwing
FORM Y�R
HC70
%�-�� certity th� e 1�t� ot March, 20
real property fw which a Homestead Pmperty�c Cre it hereby daimed:
GIBSON COUNTY AUDITOR
i(We) owned ❑ Are buying under contract
Have a benefidal interest in ihe enfity that is liable fw Ne pruperty taxes on the property and that owns Me property or is buying under a contraG.
Ii W�v�g on cmVacl, Fee Simpe wmera rroma
Recaders ofGce where wnUaa is
counry
Twnship
Recad numbar � Page
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Parcel number Leg I descriplim I Is Ihe property in ques(ion:
s�.�4� .(C��s( .3Y3il�3Sri��� ❑ R�� wovertr ❑ Mobila Fbme (IC 61.1-n
If arry partion of Ure residential sWCWre w ihe Wnd na exceedirig orie (1) xre Ihat imm�ately wrrounds Ihal slnictura is used �o pmduce inmme, descnbe the use aM pwtbn
at Iha properry uGGzetl in Produce inmma.
�2G -�9 -��- 3�3 - oo�. syy- � a-�
•.• . .: . .
Counry Twvnship Counly Tavnahio
i hereby certi(y �he above shatements are We, correct and complete. �'9��"re ot daimam
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(numberaM streel, tity, siate, and LPCOAe)
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Land not ezceeding 1(orre) ave immediatety --"��'��: �-' -
:.;�,.,.,.�...
surtoundifq7 residential improvements. (�) :.y':.; •=r 5 %: _ ,. � .
Oiher Wnd �p� ..:j+ ` '
.r-zs� .
Tdal larnf (line 1 plus line 2) (g�
4 � y� c
Residential imprwements orMnualy ����� (4� - - � ` } : '
K..
Assessed Mobile / ManuFach�red Home �;5' f-.
Garage �5)
�... . .� �n...
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Other improvements (6) "
Tdal improvements (line 4 through Gne 6) �7�
TUai value (line 3 pl(s Grre n �g�
I hereby certify the above i5 We, cOfrect, and Signawre of Assessor Date signed (monfh, tlay, year)
complete.
veriryfrq aaa, - sipnawre or nuaitw oate signea (mmm. ear. rea�
�.-� � � • •
20 pay 20 _ 45.p�p for 2007 pay 2008 42.000 for 2010 pay 2071 I
Lesser of 12 qq,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuatirn S
a 43,000 for 2009 pay 2010 40,000 payable after 2012
Signatura of �tor Date signed (month. daY. Y��) , I