Homestead_Davis (3)�
•"'" CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD/SUPPLEMENTALDEDUCTION
State Form 5473 (R72 / 6-09)
�O f Prescribed by Ne Department of Local Govemmerrt Frence
INSTRUCTIONS: See ieverse side lw fiiing insfructiona.
i���a.
FORM YE�
I(VJe) - certiry Nat I'hmj�pied, my (our) prindpal
place of idence or am (are) buying the following described real property for which a Homestead Property Tax Stan��da�uclion�' hereby daimed
under conUacl on the date Ihis applintlon is filed, (date o/filing): � GIBSON COUNTY AUDITOR
❑ I(We) own � ❑ Am (are) buying under recarded contract -
❑ Am (are) entitled to ocwpy as a tenant-stockholder of a cooperative housing corporation
� Have a beneficial interest in Ihe Wst or the right m occupy the property under the terms of a qualified personal residence Wst
Name ahnant(kgalnemej- �
�
�
Drrvels Grense / Idantifxatian / ONer number
01 daimarrt's spouse (last five dg'AS)
Legal Uesaiptim
Nwn.
Is Ue P pelty m queslion:
C
Recad numbr!
Page
K/'� � �`�""�'� /w �' # � I ��� OroOenY . ❑ MnwOy assesse0 moGle home (IC bf.1-n
If eny portion ot Ne residential strumre or Ure WM not exceed4g ane (1 J acre Nat immediately surtaunCS that sWCGire is used W protluce IMpne, desalbe ihe use anO porUOn
01 the P�7eMY utifaeC to PmAUCe mcatre.
a(� -a�1-�a - 300 - ood- 3 vs-o ��{ •
Counry
Township
I hereby certify the above statemenis are We, correU and complete. .�'
ciry, sfare,
Land not ezceeding 1(one) acre immediately
Otherland
Total IarW (line 1 plus line i)
Rcvltlential impravements or M
Assessed Mobib I ManuFacturetl
Other Improvemenb
Dwelling
Garage
i+)
cz>
(3)
(4)
(5)
(6)
Total improvements (flne 0 Nlough Ilne � (7)
7otal value (line 7 p!w line � (8)
I hereby certify lhe above is We, cortect, • Sig�ature of Pssessw
and complete.
Veilyci9 artbn - SignaWre o(lu�dtor
Counry
rownship
�%�*_/1����!�/�
�� —_ —°_
20 _ pay 20 Lesser of 60% af Ne assessed value of the homestead or $45,W0
NdxMAStarMCg eny aherpovisiolti Ne sumW the deductions proNdr,d in IC Ctf.7-77 to a mo0➢e home Ihat is
not assacred as real property w to e manNaCUied harie (hat a rot esseued es reel properry may rwt esresd
me-haHl12) d(he esseued value W fhe moD'de home ar rrenufactured froma.
$
Date signed (mon/h, day, year)