Homestead_LuhringCLAIM FOR HOMESTEAD PROPERTY TAX FORM �
__ STANDARD / SUPPLEMENTAL DEDUCTION HC�o
' Stale Fwm 5473 (R13 / 12-09)
�,�� � Presaibad by the Department of Local Gwemment Finarae
INSTRUCTfONS: See reverse side forfiGng insWetions.
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I(We) [f� 9�- certiry that I(we) pi�as'my og��" 'pal
place of residence w am (are) buying the follo described real property for which a Hom te d Property Taz Standard Deduction is ere�qv
�er contract on the date this appliration is filed, (date ol fili I(We): �PR Q
� 2��2
Own ❑ Am (are) buying under recorded conVact
� Am (are) entitled to occupy as a tenanbstockholder of a cooperative housing corporadon ` C���
❑ Have a benefidal interest in Ne Wst or the right to occupy the property under the tertns of a qualified personal residence Ws1�
❑ Am (are) lhe shareholder, partner or member of Ne enfity ihat owns �he property. G�BSON COUNTY q� TOR
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It 6uying on coMrad, Fee Simp�e owners name
Recordels ofice wlw.�e conveU is recarded Record number Pape
"'�" ' � ' �
�my �/ � 7wms�ip Tarirg . . ( � , fown,'ro,,w,nsh`iP)
U ��--� !l�/
Patcel number Legal tlesaiption Is the perty in question:
`/i�u oS(.�., ��o - 3-/� r�i wouem ❑ nN,�o� ��a ��a r� vc s-,.,-n
II ' of Me �esidentlal structure or the land not e:ceeding one (1) a�re Nat immediatety surrour�c that sWmre is used to pmduce "v�mna, Aesaibe the use and pMion
W uti0rtd to P�� income. �_ iJoZ .�
_ /ni-3� - 03� - oc� , Sa/- 6d �f
-.. . . : . .
Counry Tamship Counry Tamship
1 hereby certify ihe ehove statements are We, cortect and complete. �^a� of daimant _
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(num6ar eM street, tiry, sfate, aM ZlPOOtla)
(oz�3 S `+7S E u���sf�d+ IN 4�65
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su rrtoundi X�`�esldenunl m� reovemenue.d��y (�1 �.,�� .���"s�i�'� ''-�
K, d,+
. ,y y<+`
OlhellBnA �2) .h _ 'y`4ry`yG
rom� �ana (�irre , aw �iire 2� � (3>
ResiderrtialfmprovementsorAnnuafly �Iiing (4) ,.,��*�;�s'�a �.:t.`y..��-�p«�{�-,.Y.,
Asaesaed Mobtle I Manufaehned Home Gara e ,s`r�� �` �`-'^'-,.�s 7i 5�i5� �"` 5y
9 �5) ..�u;.._. ._ -a °.�X _..._.:`3�
Otherimprovemenb ifi) r� � :.;��s ;¢ _ _
Totel ImprovemeMS (11na I Nrough line � (7)
Tomi velue (/ine � plis nne n (8)
I hereby certify the above is We, correet, �fe°"� °���� �� �`� (`�N, �y �A
and complMe.
VeiM�9 aIXbn - SignaWre oflwdimr Dete s19ne0 (monN, daY• Yee�
�..� � � • �
20 _ pay 20 Lesser of 60% ot the assessed value ot the homestead or $45,000
MofwiMSfendirg any ofherp�ovisiai, Ote wm o(Ihe deductbrts provided in IC &1. f-f2 to a moWe /ame Nat is $
not essessed 85 real pioperty or ro a menNactwed home Nat is nof essestetl es real pioperry maY nof exceee
ona�hatl (121 a7Ure essessed velue o7fhe rta6ile hama wmamAxtured hane.
g�y� a�p��� Da[e signed (month, dey, yea�