Homestead_HornbyCLAIM FOR HOMESTEAD PROPERTY TAX
�._• � STANDARD/SUPPLEMENTALDEDUCTION
Sfate Form 5473 (R72 /609)
�O �,� � Prescnbed by Ihe Departman� of Laal Gwemment Firance '�1
INRTRI ICTI�INS� Sm m�m.ee ��de �. n.;.,..:..��.....r,..... � tl
___._-___ _.__._. _....�..._..__"_"_' �
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��e) cer�ify that I(we) �pied as my (our) principal
place ot residence o am (are) buying the following described real property tor which a Hom ad Property 7az-�, dard Ded�l�n is hereby daimed
under conVac[ on Ihe date this a lica6on is (led, p'� � F� "��'
PP (date of fili
❑ I(We) own ❑ Am (are) buying under recorded convact GIBSON COUNTY AUDITOR
❑ Am (are) enGtled to occupy as a tenant-stockholder of a cooperetive housing corporetion
� Have a beneficiai interes[ in the Wst or ihe right to occupy the property under the lertns of a qualified personal residence trust
�• • •
Name a( daimant Qegal nama)
SadalSmmywmherdtla'�
Name of tlaimanYs spou al name)
Sacial Sewriry num oi ant's s se jW,s� five tligits) Orivefs license / IGenGflcatlon /
. .•� �
tl huying on contract, Fee Simple wmeYS rame .
Recortlefs of4ce where mnVad is recarded Remrd num6er Page
. . � • " � • �
Couny Twmship Ta�tinp datrid (rity, Mwn, fownshiP)
nu her ��� p� Is perty in ques4on:
aeai wo�rty ❑ Annuypy ass¢ssed rtnbile home (IC 61.1-�
�any poNai o( the residential swcWre or the W�d not exceedifg wre (1) aae that immetliatety surroun0.s that swwra is useC to produce uioome, desnibe Ihe use aM poRion
i the P�PenY ��Ta� � p�uce income.
• � • • � : � •
Counry Townshiv Counb 7ownsWp
I hereby certiy the above statements are Vue, correct and complete. ' o`f p�aimam �
V.�
e (numberaMStree(ary,sfafe,aritlZlPcoda)
� s � �f�c�aq
.- .
, . .. . ,
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Land not exceeding 1(one) acre immediatety �..�� *�";��-'t4qs'�, j�s!-;�,%;
surtoundin residentialim rovements. ��) "�*".=�q,.�'''�„+f,,�x:,'.�H >�°�.-�:E
'4=�' �j:."s� �
Other land (2) `" �_'="��'�'�`'�
-'��...
ToUI land (line 1 plus line � (3)
Dwelling (4) �it` ��'3:;� '��.(�'�i.�� .
Residential improvements or Mnualty
..";.. l � E:3-'i.'L 'C..�t:..t.�:
0.s5rssed Mohile I ManuFactured Home Gara e ) �-�„++n�"�' ' h-"�.�' �� � � r T��
9 (5 .tt.. e�,.v..s�%?S'.ii:s•:
Xrx.
Olherim rovementa 6 ''�'�`'�+,??:,ti}> u
P � ) �,_ +i _'r-.
Tatal Improvemenb (llne I through llne 6) (7)
Total value (llne7 p(`s Iine 7� (8)
I hereby certify the above is true, cortect, Signatura ofASSessor Date signm (month, day, year)
and complete.
Vaifyirg action - Signature of Autlilw Date signed (rtronN, day, yea�
�..� � � � •
20 _ pay 20 _ Lesser of 60% ot Ihe assessetl value of Ihe homestead or $45,000
NMvi(hsland"ug eny ofherproWSbn, ihe wm a/!he tleductorts pra�idMin IC 67.1-12 ta a mobde home Ihaf ic S
not auessed as real properry w io e manulartured hwne thaf k rrof assessed as rea/ propeily maY �t erceed
one-haH(1R oI Na assessed value ol fhe rtpbde home or mnwfarluretl hwne.
' re iwr Date sign j�n�ny,i tl�y, yEa�
C.�-�J lJ