Homestead_Wagner�' CLAIM FOR HOMESTEAD PROPERTY TAX
� rt ? STANDARD/SUPPLEMENTALDEDUCTION
�•. �^ State Portn 5473 (R72 / 609)
�� 2 Prescnhed by Ne Depariment ol Local Govemment Firiance
INSTRUCTIONS: See feverse side tor filing ins[ructions.
FORM YEAR
HC10
� Y � � �
I(we) certiry that I�Bcce�pi�d a`s my (our) prindpal
place of reside or am ( ying the following describe real property for which a Homestead Property Tax Standard Deduction is hereby daimed
under mnVacl o ihe date � appliraGon is filed, (dafe o(filing): �i'i�a� �,(!,_
�� �� '� i!�
❑ I(VJe) own ❑ Am (are) buying under recorded contract V
❑ Am (are) entitled lo occupy as a tenant-stockholder of a cooperaUve housing wrpora6on GIBSON COUNTY AUDITOR
� Have a benefiaal interest in Ihe trust or the right to occupy the property under ihe terms ot a qualified personal residence Wst
Name of tla"unam (legal name) �
��r
� s�,,���t cm�fr.� ��
(la5t fNe
�a o�NeN
of daimant (last �rve d'giGS)
Dmw1s tirense I Mentifration I ONe
ol daimanYS spouse (Ws! frve dgiGC)
���
If buying om m�traa, Fee Simple ownefs riame
Recorders afice where mnvaa is remrdetl RecorE number Page
..�. _ � . �
Counry rownship raxing 1eisiria (ary�, ro�w�n. to+�Jh rp)
`y^'�1.C.7 �" \l
Parcel num6er Legal desmiP� Is a proPrJty in Ques�on:
� al property � MnuaAy essessei mobile home (IC 61.1-�
If any portwn af Ne resitlential stn�c4ue or the W�M rwt exceedirg orre (1) arle that "unmediately surtou s Iha[ swcNre is useO In pmCuce I�xorne, Eesmbe Ne use an0 portion
of Ihe pmperty utif¢ed to produce inmme.
�, (o-��-�a -,a� -a� 1 .v��'-oas
��
Tamship
1 hereby certify the above statements are we, correct and complete.
Atltlress (numbe� aM street, cit
�t
. .-
Land not e:ceeding 7 (one),
surtounding reSldential imp.
Otherlantl
Total land (line 1 plus line 2)
LPtode)
immediately
ResidenUal improvements orMnually �'eliing
Atsessed Mohi@ I ManNactured Home Garage
Other improvements
Total improvemens (line d through line �
Total value (line7 plis line �
I hereby certify the above is true, cortect,
and complete.
Vaitying actirn - SigruNre ofFwdimr
v
(�)
(Z)
(3)
(4)
(5)
(6)
Signature of Assessor
Counry
a
20 pay 20 Lesser of 60% of Ne assessed value o! Ihe homestead or $45,000
NohviNSlantlirg any otherpmvisan, Ihe sum o7the detlucliau providetl/n /C 6-7.1-11 to a mobi/e Mme Na/ is g
rwt auessetl as real proparty w to a manulaaured home Nat is rot assessed as real pioperty may nat erceed
one-hatl (72) o/ Ne assessetl value o71he mob�e �ome ormanu/actured home.
SignaWre o(NWitw
Township
l✓ c i.� e r'
Date slgned (monfh, day, ysa�
Date signeE (monN, day, yea�
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