Homestead_AdlerCLAIM FOR HOMESTEAD PROPERTY TAX
_ STANDARD / SUPPLEMENTAL DEDUCTION
SFate Fortn 5473 (R13 / 12-09)
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���13
FORM
HC10
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INSTRUCTIONS: Sae reverse side for filing insWetions.
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I (We) certify that �T �mY (our) priruipal
place of residence or am (are) buying the fdlowin scribed real property for which a Homestead Property Tax Sfandard�uction is hereby daimed
ier co U on the date this application is filed, (date o1 filing). I(We): C.�.r�� y
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❑ Am (are) buying under recorded contract V
� Am (are) enlitled to occupy as a tenant-stockholder of a cooperotive housing corporation GIBSON COUNTY AUDITOR
❑ Have e benefidal interest in ihe Wsl or the right to occupy ihe property under the terms of a quaiified personal residence Wst .
❑ Am (are) lhe shareholder, partner or member of Ne entlty that ovms Ne property.
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HameW t(kga/neme)
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Name of dalmanYs spaae ( al name)
Social Seariry
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If buying om m�vaa, Fee Simple awnets reme
Recordefs ofixs wM.�e canirad is recortled Record numbM PaBe
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Counry iownsnio Taring distrkl(cdl: trnm� townshiP)
Pa mber Legal desaiption Is tha property in question:
� �� � Real proputy � MnuaVy essessed mob�e home (IC U7.1-n
If arry portion ol iha residaniial sW cture or Ihe Wnd not exceetlinp ane (t ) aae that immeAiatety surtounds ihat sWCture is used W produa income, desaibe Ihe use and portion
a Na poperty utiltred to produca Irrcome.
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Counry imvnsAip Counry 7wmship .
I hereby cer6fy the ebove statements are We, correct and complete. Signa re imam
Fdd (/� r eM sfreet, dty, sfate M ZIP oode)
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Lantl not axceeding t(o�re) aere Immediatety ' s% }° '` � ry�i � `�' %
surroundin resldenUal Im mvemenis. (�) �"��, }:; � � � � �`-"�-�'
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Othar lantl (2) .1 _ �, ��.:� yh'
7otel land (li+re 7 plus 16re S) (3) �
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ResideMiallmprovemen6orMnually �Iiing (4) �^; �2# qe �.t`�� -�;,� ._
Atseased Mohde I ManufecW ted Home f�s„^s c i-' z r'�`�` -i>
C'arege (S) _ �s�'�` �T.rr . :-.: -''''-R-'. .-. - --
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Otherimprovements (F) '�., �-a'.
Total improvemeMS (llna ( Mrough line 6) (7)
Total value (line 3 pl�s Ilne � (8)
I hereby certify the above is We, correet, �9"a� otASSessa Date signed (mwrth, deY• Y��)
and complete.
Veif�vig edbn - SigraWre of Auditnr �� �9� (^b^�• �Y. Y��
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20 _ pay 20 _ Lesser of 60% of the essessed value ot Ne homestead or $45,000 '�
NoMiMSterMbg any oMerplovl5ion, fhB sum o/M1e tletluC(iDra p✓DVitled tr11C 67.7-12 fn a lroWle hDme Nat'a 5
rat assessed es real property or ro a menufadured home Naf is ral essessed as 2al pioperty mey rrof exceed
one-hatl f/t) olNe essessetl rdlue o7fhe mobde home w manWaCUred home.
c��p�� a� p�i� Date signed (month, day, yea�