HomeMy WebLinkAboutHomestead_Weaver (3)"'" CLAIM FOR HOMESTEAD PROPERTY TAX
� _ A, STANDARD/SUPPLEMENTALDEDUCTION
State Fortn 5073 (R72 / 6O9)
�O � Presaibed by Ure DepaNnem of Loral Govemrtierrt Frence
MSTRUCTiONS: See ieverse side /or fili`g insLUCtions.
FORM YEAR
HC10
FILED � -
� • •
� N'�e) certiTy that I(vre) occupied as my (our) pri�pal
place of residence or am (are) buying the fo�lowing described real property for which a Homestead Property Tax Star�r80L ep�`\irlsyereby daimed
under conVaq on �he date this appliration is filed, (date oflling): � v V
❑ I(We) own ❑ Am (are) buying under recorded contract GIBSON COUNTY AUDITOR
❑ Am (are) enlitled to occupy as a tenant-stockholder of a cooperative housing corporation
� Have a benefiGal interest in the Wst or the right to occupy the pmperty under the terms of a qualified personal residence wst
•• . •
Name aimarh Ineme) •
Name ot tla'm�anPs s/p'o�use�(leg�el n�ame)
l.C/ 1Mtii '
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tl buying om m�tract, Fee Simple ownefs rame - .
Recordefs offica whe2 mnt2d is remNed � • Recwtl numbu Page
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Counry Township Te�dng dis � township)
r�elnu r�� �e9e��e5aiP� . Is pWpertyin4ut5iim:
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rT �J T L�neat yopeny ❑ Mnua�y assessetl mod7e homa (IC bf. f-�
It anY Pubon U Ne 2sidenclal sWCnire or Ure IaM rnt em�etling arre (7) aca �hat ImmedWtety surtounds that sWCWre b used to yoduce inarrie. tlescriCe the use and portion
� m me wocam w�ea m,�a� m�. ,
-.• . .: . .
Caunry Trnmship Counry Towns�ip
I hereby certify the above sfstemenis are We, correcl and complete. Signatu ai ' n� �
./4'1/
re (numDe� aM atreet, city, , e Z )
�00 0� � � s ?,/V S� �3
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. . .. . ,
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Lane not ezceeding 7(one) acra Immetliamy .��:.�„�y�j "�"'" �u�t,'!�*``�
surroundin residentialim rovements. ��) ._�;�_�..�::-.,�,„_?'G.+:°-�s.�;-.<
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Otherland . (2) ' '.:.�a;�,.��,.�.,_' r
7otal land (line 1 plus line � (3)
y��, � �c. 'r«iT'+S„x
Dwelling (4) �_",��.X��i`4��c"�i'".���' ,c„~�i;'d��§
ResidenLal Improvementa or Mnualty
Assessed Mobtle l ManWactured Home Garege 5 `` ",F � Ai` -�c'..:fgS:
( ) t;�,_��� �'.�-k,-n_ � ��^�r;�4���
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Otherimprovemenb (6) � �`.���,,�. A,}"3:;_
Total improvements (Ilne e Nrough line � (7)
Total value (llrre 3 plia line � (Bj
I hereby certify the above is We, cortect, SignaNra ofAsseswr Date signeA (rtronth, day, yee�
' and wmplete.
Veifyi�g aUion - SigriaW re ofluiCta Date siBned (rranN. daY. Y��
� �.-� � � • •
20 _ pay 20 Lesser of 60% oi ihe assessed value of Ne homesteaA or 545,000 .
NoMitAstand'rg anY �erprosison. Ne sum d fhe dedulions prooiticM in IC &1.7-7Y fo e nwb0e hanre Nat is $
nw essessea es ,ae� w�Pam or m e,rem,racn„ea nonre rAar'ts nw assessea es ,ea�wnaem may nw euoem
one-haH(/ o/Neascessetl uea7 mobilahorrieormanu/aUUredhane.
5gnawe of Date sgned �r�a� h. day�year) �/
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