Homestead_Pohl (14)! "'" CLAIM FOR HOMESTEAD PROPERTY TAX
% � STANDARD/SUPPLEMENTALDEDUCTION
S• State Form 5473 (R12 / 6-09)
�O •� PrnsuiCed by the Depariment of Local Govemment Frercx
INSTRUCTIONS: See reversa side /or filino instructions.
FORM YE'�
HC10
. , � ,
� M�e) certity that I(we ocwpied � (our) prindpal
place of residence or am (are) buying th Ilowing descri6ed real operty for which a Homestead Property Tax Sta�G��flc��fi�ereby daimed
under conVaG on ihe date ihis applirati s filed, (date olfiling):
❑ I(We) own GIBSON COUN'TY AUDITOR
❑ !vn (are) buying under recorded contraC
❑ Am (are) entltled lo occupy as a tenant-stockholder of a cooperaUve housing corporation
� Have a beneficial interest in the Wst or the right to occupy the property under the terms of a qualified personal residence wst
•• • •
. .-, .
tl buying om m�traq, Fce Simple ownefs name
Reoordefs of4ce wfiere mntrad is remded RemM number Page
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Counry TbwnShiP Tarirg dis�rict (�Y. � �0
�numher Legal Eesaiption Is Ihe in question:
: - a r�o a Real property ❑ MnuaOy asSessed mobile home (IC &1.1-n
�It any poribn of Ihe regdenilal swcWre w Ihe land not exceeding ona (i ) arne Ihat immetliatery surtountls ihat sWCwre is useE �o produce income, desaiba the use aM ponion
of Ihe property uNaeC m pmtlure inmme.
-�• • � a � •
Counry Tovmship Caunry Tawnship
hereby ' the bove tstements are We, cort and complele. �"3.,fa°'�e ol daimam �
�C/
Cress (nu 6er antl straet. a s/a.e. end LPwde) � O � '� I^ `� S N ' ��/ � G
�W j i l.l, L/ / V (!/ /
�. � � • •� • �
i i'. •
Wnd not exceeding t(one) acre immediatety � ���.,�,3qs�+�.. �3L' ,� y���°�.
surrountlin residential im rovements. �� .-.5-,. S^-' 1 ���� ��?`��``-�;.
'S::, f �gn-�.:
Other land (2) ' r b„"Yj+,-Y .,s.��.
Total land (line 1 plus line 2) (3)
Dwelling (4) wc..F:}_#"�n v�i* "� t4"f - 1?rx
Residentlal improvementa or Mnualty �'�� ��� � � �£
a �xsET^'�5€ .ft-EZrwS
Assessed Mobile I Manufactured Home - � ��' ""� � � ..
Garage (5) p����.ti w�t?`?, .F'��u.r.i�?
Otherimprovemenss (6) '��''.�':`.iF ,.+�;rh-T=
:t..... :X.�^ _
Total improvements (line e through line � (7)
Total vatue (line 3 pl1s Ilne � (8)
I hereby certify the above is true, correct, . Sigriawra of Assessor . oa;e signea (monrn. Eay, yea�
and complete.
Vai/ying aaion - Sig�aWre of PaWirur Date signetl (rtronN, day, yea�
�.-� � � � •
20 _ pay 20 Lesser of 60% of the assessed value of ihe homestead or §45,000
NWwilhsLarcling any ofherplavislon, Ne sum ol fhe deducliorts providetl in IC &1.1-72 fo e moM7e home /hat is g
ro[ essessed as real properly w to a menutaUUred hm�e Nat is rrof essessed es real properry may rot erceed
on (7Q) W Me a uetl lue o! Ne mobde Iwme or manufaUUred home.
' n i[or Date si9netl (month. Cay. yeaA