Homestead_Schmits (9)\
"p CLAIM FOR HOMESTEAD PROPERTY TAX
_rt '; STANDARD / SUPPLEMENTAL DEDUCTION
i ' State Fortn 5473 (R72 / 6-09)
S,��. ' PreunbeC bY �e Departmenl of Local Govemment Firiance
INSTRUCTIONS: See raverse sitle for filing instrvctbns.
�
FORM Y�
HC10
� P. .� �
i�e) ps�i r r iv � r tr�i �� ip l." ceAify Nat I(we pied as my (our) prindpal
place of residence or am (are) bu following described real prope or which a Ho d Pro nda Dedudion' hereby daimed
under conVad on ihe date this appliration is filed, (date of filing): l�a� '�' �
❑ I(We) awn ❑ Am (are) buying under remrded convact GIBSON COUNTY AUDITOR
❑ Am (are) entitled to occupy as a tenant-stockholder of a cooperalive housing corporation
� Have a beneficial interest in Ne wst or the right to occupy the property under Ne terms of a qualified personai residence Wst
of daimant (last frve
� � �
Sooal Seanry number o( tlaimant's spouse (last five tligrts) Drivrfs Gcer�se / Identifira�ian / Oiher wmber
ol tlairtant's spouse (last frve d'gds)
1f buying on rvntrerJ, Fee Simple ownefs �ame
Recordefs ofice where mnvad
Township
Counry
Township
I hereby certify the above statemenis are we, correcl and complete.
Address (number antl st�eet, ciry, slate, and LPcode)
Land not exceeding 1(one) acre immediatety
surtounding residential improvements.
Otherland
Total land (line 1 plus line �
Resldentlal improvements or Mnualty �����9
Ass�setl Mobik I Manutacwretl Home Garage
Other improvements
Total Improvements (Ilne d through llne 6j
Total value (Ilne 3 pha line 7)
I hereby certity ihe above is true, cortea,
and wmplete.
Vaifyi� action - Signawre of Autlitor
(�)
i2)
(3)
14)
(5)
(6)
Synatura
Ta�dng disiria (rify, rown,
Iswing Sta�
Issuiig State
Record number Page
�teal property U AnnuaDy essessed mobile home (IC &f.1-:
Nat sWCNre is used �n pmauce inmme. desaihe Ihe use and portbn
of da'imant
20 pay 20 _ Lesser of 60% of the assessed value of lhe homestead or $45,000
Notwilhstandirg any Nher provision, ihe sum ol Me deduUion.t provideJ in IC 61. f-12 to a rtmOde home Nat is
mt assesseC es real property a lo a menuFaUUred home Ihat is nof essessed es real pmpeM may nat erceed
one-haH�72� W Me assessed re/ue o1Ne moGtia �ane a manufarturetl homa.
ure of PLdi �
��� �,
S
Tuxnship
Date signed (rtronth, day, yee�
Date siqned (monN. tlaY,
�