Homestead_Cardinal'°.nnv
4 : CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� f SGte Fortn 5473 (R5 / 70-01)
Prescribed �y ihe Departmen� of Local Govemment Finance
INSTRUCTIONS: See reverse srde for filing instructions.
FORM YEAR _i
HC10
�
�
I(VJe) � o � �, S Q n � e� c ify that on th�7 st y of March, 2
I(VJe) oaupied as our principal place of res' ei e tl Ilowin scribed real property for which a Home i i � y imed:
�(pp]�....�� GIBSON COUtiTY qUDITOR
(VJe) owned ❑ Are buying under wntract
�ave a benefidai interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contrect.
.�'""-.sta-.'.�'�`s3�..'�: -i�'.n`=,`. .'n� �'".'.:,. �' :�,�_� : � � s _sCONTRACT'RECORDED:...:_, . �„ :,�- , -y _ .. .. - .
�
If buying on con�ract, Fee Simple ownefs name
Remrders ofice where conlract is recorded Remrd number Page
Couniy Tavnship Tadng dislri�t (city, fowq fownship)
Parcel number egal descnption Is the property in queslion:
i — —' � al pmperty ❑ Mobile Homo p.C. 67.7-7)
If any potlion of lhe residential sWcWre w �he land nol exceeding one (1) acre lhat immetlialely surtounds �hat struc re is used �o produce income, descdbe lhe use antl portion
of Ne property uWized to produce inwme.
� �•� S� o`i •
�- �i��?3 -�6 - �Oo1. 40�" - Do�S
�-;•�=.,�t.f-E �;';��'�hty� ..�.;n` i.. �, s�"..�PROPERTY;OWNED'BYCIAIMANT�IN�OTNER"COUNTIES� .. . -z�. -"`<'�� � `�' �� -'-; --'i "��-�
Coun�y Tavnship County To.vnship l
I hereby certify the above statements are W e, correct and complete. Signai ot dai � •
�
^^dress (number and street, ciry, sfate, ZlPcode)
R R. I Bax �l'i-�-ya fL. B.�., r"n!
.;
����` ASSES OR USE ONLY s �. ���`"* -::?�TRUE TAX Y� ASSESSED VALUE HOMESTEAD ,t ��NON-RESIDENTIAL� ��,
��e.?� ��::�._a{�s,.���--?��� ,�`._.,r_. VALUE.` � �AT100%OFIIV,.t. VALUE_M�:�y�^u.�}..:f.yVALUE....�a�E-':-t}.
Land not exceeding 1(one) acre immediatety �'+ `�pf�'" �„'� �3'��r �-3
surrounding residential improvements ��) �-` M ����_ �� �' ���
�� v
Other land z � �^�"�� �
( ) �Tx=•zr� _.,._.-�
�.ts>.,..:.;°-�-''_
Total land (line 1 plus line 2) (3� '' �� �
.,�� h �.F-4 p vF �.'-�� :
Dwelling (4) r}�--u.�t �-e �v n '�.�"�`"�� 's
Residential improvements � �,. ,,,a_ �.
Gara e �"€��7 �'�-�„u�-�'t�r � .�..'•
9 (s) �ia�`y,'�rs�,�,' .���fzL.�::
a �x a.
Olherimprovements (6) ` c-� � `�r=
.�''�s _ w
- " -:.ti..�:;�c -�=
Total improvements (line 4 through line 6) (7�
Tdal value (line 3 plus line n (g)
I h¢reby Certtfy Ule aboVe IS W0, corteCf, and Signature oFAssessor Date s'gned
complete.
Vaifying aclan - SignaWre oflwdi�or Dale signed