HomeMy WebLinkAboutHomestead_LizcanoCLAIM FOR HOMESTEAD PROPERTY TAX v FORM YEAR
CREDIT/STANDARD DEDUCTION � Hc�o
Slate Fortn 5173 (R6l M3) � �
Rearnbed by the Depert�mnt of L�al Govemment Finance ��
INSTRUCTIONS: See re�arss a7da b 18rg ixburbipro,
��'#t=-,c�Y��'r.�:. ,�:r�°�a`.'�'�'�-. ���..�'�CERT7FICATION�STATEMENT�i _.r.'.:�;>:,%s�:"'_��;��F..g �-. ra{s,.:--3-`.�-��'.��.�.�,•
I(We) certify that�or� the 1 sb�Gey of March, 20
I(We) occupied as our ' cipal place of residence th owin described real m e for which a Homestead Pro e a� N.r� —
9 P P rtY p rty�T��c Credit,is hereby daimed:
❑ I(We) owned ❑ Are buying under contract
QIBSON COUNTY AUDITOR
iHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on conLad. Fee Simple owners name
RemrAefs olfice where conVacl is remrded
Tavnship
-DOSa6-oC�
If any poAian a( Me residential sWCNre w Ne WnE not exceeding one
of the prop/ert�y uGl¢ed to produce iricome.
/ �Ii�(1X�` .
via
Tating tlislrict
Rewrd number
property ❑ Mobile Homo (I.C.
Page
immeAiatety sunounds that swcture is used to protluce income, describe the use antl
�� � � � '�'��`�''w'� "S-��.. . - �-�S�s' i� xs.w�^o�� - � -�a.� `� r� , =�.:
T�-"' ASSESSOR'USE ONLY � '��s, "�= i TRUE TAX � ASSESSED VAIUE HOIdESTEAD �jr-�,L, NON',y�tESIOENTIAL :�(}�q,-?
-'�- �"z�� � �� ., `-°� ��YALl1E�"�',`� �AT 100°/a.OF�'TN� �,tr;�� VALUE�� �+�-���VALUE�`•:.�,
Land not e9ceeding 7(oneP aae immediately (' � W���wyr�����`4.�.,`�,'� s��'?�
surroundin residentialim rovemenis. ,��v t:,����z-�,.� h�,
�
Other land `i��"t� r"�+ � '
�Z� =f%����
Total land (line 1 plus line 2) �3�
'� T c �y�` .Y'*��
,.%, r.' � �
Dwelling (4) :� a* �'" ,�u ��R�i t g� �a;
�Rasidential Improvements orMnuaOy r"� i°'���'�''��`'�'��1'��"�
Asa�aed Mohlle / ManufacNred Home Garage (5) �'�.s���.-°'�''��� �'�:5�g�a#y=
, �
+n �' i�-:3�-
i`2��-y�. �f
Other improvements (g) . � a"V .�-'.�,2r.� z
� ��.i�l" �F
TUaI improvemenfs (line 4 through line 6) (��
Tdal value (line 3 plus line n (g�
1 hereby certify �he above is We, coved, and Synanre ofl�sessor Date signetl
complete.
Vaifying action - SignaMe oflwditor Date signed