Homestead_Heldt (10)� �
d" CLAIM FOR HOMESTEAD PROPERTY TAX
� . ' ?; STANDARD / SUPPLEMENTAL DEDUCTION
i•. — State Fortn 5473 (R72 /609)
S,�� � Preunbed by the DeOariment ot Lo�l Govemment Finance
INSTRUCTIONS: See reverse side for fifing instruclions.
�����
YEAR
A�� 4 Z 09
GIBSO�OU �� �TOR
��We) certity that I(we) occupied as my (our) pri�pai
place of r nce or a re) buying the following desaibed real property for which a Homestead Property Tax Standard Deduclion is hereby daimed
und nllact on Ihe date Ihis applicalion is filed, (date olfiling):
I(We) own ❑ Am (are) buying under recorded conVact
❑ Am (are) entltled to occupy as a tenanFStockholder of a coopera[ive housing corporation
� Have a beneFidal in[erest in Ue Wst or the right to occupy Ihe property under the terms of a qualified personal residence Wst
spwue (legal name)
spouse (�act
If buying om m�vact, Fee Simple ownars name
Rxorders offrP where tonVaq is remrded
Caunry
ol daimant (last frve dgiLSJ
Drimm.rs Grensa / Identifica�ion / ONer number
ol daimanYs spouse (las! frve digiGC)
distria (ri(y, lown,
Is Ihe property in qu�tion:
IssuuS State
Record numDer I Fage
'�d ` (��V • y{/q �{�p� V al 5 I U Real property U Annualty assessed mobile home (IC 6-7.7-n
portion ol ihe revdentlal swcwre w Na land not exreeding are (7 ) arre �hat immeCiately wrtounds ihat swcWra k useE to pratlur¢ incoma, Oescribe lhe usa and porten
Pmpeny uulaeE m produce inmme.
Counry
Township
I hereby certiy the above statements are we, cortect and complete.
MAress (wmber and sveet, ary, sfa(e, antl Z1Pmde)
Land not exceeding 1(one) acre immediatety
Otherland
Total land (line 7 plus line 2)
Dwelling
Resitlentlal improvemen5 or Mnualty
Assessed Mobile 1 Manufactured Home Garage
Other improvements
Total Improvements (line 0 fhroug� line �
Total value (Itne 3 p/�s I/ne 7)
I hereby certiy lhe above is Irue, cortect,
and complete.
Vaityifg aUion - Signacure ot Auditur
a)
(3)
(<)
(5)
(6)
Counry
tlaimant
20 _ pay 20 lesser of 60% of the assessed value of the homestead or $45,000
Notwi�hslaM"ug any olhe�pmvision, Ne sum d fhe detluctiorts provided in IC G7.1-72 to e rtroE�e fame ihat is 5
not essessed es real popeM w to e msnufecmied liome fhet is not assessed as reel properry maY �� exceed
one-haH(iRl a�e assessed rd7 W Ne mob2e M a manulaaured hmie.
s�e�Wrea,wa�� n... o.�_
r�mp
Date signed (month, day, yea�
Date si9neE (monfh. daY. le�
Date y�ped
V