HomeMy WebLinkAboutHomestead_MemmerCLAIM FOR HOMESTEAD PROPERTY TAX
i CREDIT /STANDARD DEDUCTION
State Fond 5473 (R2/ 5-92)
r816
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
' 11
!A JI
YEAR
tTION STATEMENT
CEMqC
j
t rWe) certify that on the day of March, 19_
1 occupied as our principal place of residence the following described real property for which a Homestead Property T di4ffs er imed:
I (We) a owned
beneficial ❑ Are buying under contract %fl
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prop¢u�ingnl� er a co
GIBSON Cb C1i4TY AUDITOR
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district X X town, own hip)
ce ber
- o.( 7 7_
egal description
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion of
the property utilized to produce income.
v- &fUO. 177 - G6�
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County I Town i ITownship
Sign re of claimant
I hereby certify the above statements are true, correct and complete. -
ress (number and street, city, state, ZIP code) /
>z. 't�✓T 293 .An/cifC0 [o
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
-
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Signature of Pssesor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuation or $2,000
5
Signature of Auditor I \
Da sighed 6