Homestead_Kirchoff��
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
� State Fortn 5473 (R6 / 4-03)
Prescribad hy the DepaNnent af Local Govemment Finance
INSTRUCTiONS: See 2verse side for filing instn�ctions.
^ , FORM ,�C YEAR _
R7 HC10 �
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ENT'-:. ���. �.'�:n � t"�y,��'�-"`� � �: . _
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I(We) certiy lhat on the 7st day of March, 20
I(We) o ied as our principal place of residence t ollowing describe property for which a Homestead Prope�yt Cre.��t ishereby daimed:
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❑ I(We) owned ❑ Are buying under contrect GIBSON COUN7Y ��T(�fp
� Have a beneficial interest in the entity tha� is liable for the property taxes on the pmperty and �hat owns the property or is buying unde�f 3 hbntraU.
If buy'ug om m�Vaq. Fee Simple ownefs name
Remrdafs olfice whera conVaq is recorEed
Tamship
Parcel
Tating OisUJct,(ciry, tqwn,
Is
If any portion of Ne residential sWCture or the land nol e�/eding �?e (1 � acre that immedi�¢fy s� ds that
ol lhe property util¢ed tu produce inmma. (/ � ���/
a'� �� aSL�a� �a. o�� _��- ��
County
Tonnship
I hereby certify the above statements are true, correct and compiete.
County
of
�I �1ress (numbei aM sbcef, cif}; uafe, ZIP code) �� (�
g163 S. %in,qeli�. D�. Fo�r $�a..�h, In/ �`�-6�'�
Rewrd number � Page
Real property ❑ Mobile Homo (I.C. 67.7-7)
ire is usetl to produce income, describa the uu antl portion
SignaNre otlwChor
20_Pay20_
lesser of 1/2 Homestead
Va�uaLO� w 535.000
3
Date signed
F `R' lr-� w�