HomeMy WebLinkAboutHomestead_Washburn (3)� CLAIM FOR HOMESTEAD PROPERTY iAX FORM {� YEAR
� CREDIT/STANDARD DEDUCTION Hcio `��
♦ � State Fwm Ss73 (R6 / �-03;
Prescnhed by the Departmem of Local Govemmem Financ�
INSTRUCTIONS: See revcrsc sidc !or liling inslruclinns. ,
�:s= . ._ �-.:-==r i s-� �,,,, __r,.:ti-• r ... �,"'r.'. -' .:-CERTIFICATION STATEMENT::
, -. .
I(We) ' lhat on Ihe tst day of March, 20
I(We) occupied as our principal place of resid nce Ihe follo ' g described real property f which a Homestead Property Tac Cr,e��ys,her,�i�aimed:
I'�(We)owned ❑ Arebuyingundercontracl GIBSONCOUNTY DITOR
� Have a benefidal interest in the enury Nat is liable for the property taxes on the property and that owns ihe property or is buying under a contract.
It buying om m�Vad. Fee Simple owners name
Re�rders office where wntract is recorded
Counry
Parcel number
Taxnship
Legal description
IP.TION�';-�-- - �...
disirict (ciry, rown, fown;
Is the
Retord number
Page
J`— ` r0 ��� y�� I �eal praPerry ❑ Mabile Homo (I.C. Sf.f-7)
If any portion of Ne revden6al struUUre or tha Wnd not exceeding one (1) acre Ihal immediatety surrounds that swcWta is usetl lo praduce inwme, tlesaibe Ne use and portion
of the proparry utilized to produce i�ome.
County
County
I hereby certify lhe above statements are true, correct and complele. I 5- ign wre o� 'ciai1ma_ 1nt- ��
(�� �J�J.�
Ad ess n mbe� and streei, city, state, ZIP code)
� Id SoUF►, �,�s! s����{- Pnn���-�r.�- y�t��
Twvnship
��'`' ''F' ASSESSORUSEON Y -_ - . TRUETAX ASSESSE�VALUE �HOMESTEAD�' NON-RESIDENTIAIL_, � -
.:
_ _�rwe.z.., . �.:�._ .t. � .�. -.? �� .•�. VALUE �. 'AT100%.OF�_TTV •. • VALUE�: �'"i �r `ri:aS VALUE� :�� . .
Land not exceeding 1(one) acre immediatety
surrounding residential improvements. �� � .. � �
Oiherland (2) � . �
Tctal land (line 1 plus line 2) (3)
Dwelling (4) . ��i . .
.; ! ir< �.- �.,7
Residenliel improvements or Annually ,�y�. �. _� ;
AssessedMobiie/ManufacturedHOme Garage (5) :i..�;.� ��. . „ .
Other improvemenis (6)
Taal impmvements (line 4 lhrougb line 6) (7)
TKa� value (line 3 plus line n (g)
I hereby certify Ihe above is W e, covect, and Signawre of Asseswr Date signed
complete.
Vrrilying action - SignaWre of Fwtlitor Date signed .
- "- ��STANDAR�.DEOUCTION
20 _ Pay 20 _
LeSSer of V2 Homes:ead
va�uauon or 535.000
SgnaWre of Puditor
�
I Date signed
u_�s_�r_