Homestead_LeedsCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
- Steta Fam 5173 (R6 / 4-03)
Prascribad 6y Ne Department of Local Gwemment Finarxe
wsrnucnoNS: see �re,se � �eu,g;,�w�u;�.
FORM YEAR
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I(We) � �. � certiy that d ���Gj;(_day'oJ.Mna, rch, 20_
I(We) occupied as our principal place of residence the followi g�ed real property (or which a Homestead Property Tmc Credit is h by imed:
❑ I(VJe) owned ❑ Are buying under contract GIBSON COUNTY A��Ji �+�
' Have a benefidal interest in the entity that is liable for the property taxes on ihe property and that owns lhe property or is buying under a contracl.
If buyirg om m�traG. Fee Simple owner's name
Recordefs ofice whera canVaa is recorded
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County Tw�nship
Tating
Ne
o/ tlie reSiAentlal sWCture w the Wnd not eaceeding ane (1) aae Nat immediatey surtounds
y uWized lo produce inwme.
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Record number � Page
Real property ❑ Mobile Homo (I.C. 67.1-�
�re is used b D�aduce income, deuribe Ne usa and portbn