HomeMy WebLinkAboutHomestead_TinsleyCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
V / Slate Form 5473 (R6 14-03%
W Prescribed by the Departmenl of Local Govemmew Finance
INSTRUCTIONS: See reverse side for filing inslruchnns.
s'' ""''"-' -�I 1� "•* ""'-• '- 'r "P - -'. CERTIFICATION STATEMENT.-- - _ . - -1. FEB 2 2-2005
I (We) certify that on the 1st day of March. 20_
1 (We) occ ed as our principal place of residence the followin scribed real property for which a Homestead Propert�i)d�py claimed:
❑ 1 (We) wned ❑ Are buying under contract GIBSON COUNTY AUDITOR
Have 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.
CONTRACT:RECORDED' -
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
`?' ..rkar.G . , •,-r;. , _ -.. '` . -: -.�•i: • sis.«- -1,
- -_PROPERTY OESCRIP,TION r,,.
County
Township
County
Tmnship
Taring district (city, town, township)
Parcel number
Leg
'plio
the property in question:
❑ Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceedin o e
(1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- 2- 20O-f�1
(2)
�d / -eYv
u;. -'.+' ct-> ' _''_.'T* Y_' - �' "• ' -P. ROPERTY OWNED BY CLAIMANT W.OTHER'COUNTIES
County
ASSESSED VALUE
Township
County
Tmnship
I hereby certify the above statements are true, correct and complete.
Sign ure ant
A rebnu
and stroug e, LP e) (�
ASSESSOR USE ONLY :
TRUE TAX
ASSESSED VALUE
-- HOMESTEAD '
-VALUE
NON - RESIDENTIAL.,
';
., . , _
VALUE
AT 100% O -.TTV
;i• -VALUE
Land not exceeding 1 (one) acre immediately
- -
surrounding residential improvements.
Other land
(2)
- -
(3)
-
I
Total land (line I plus line 2)
Residential improvements or Annually
Assessed Mobile I Manldactured Home
Dwelling
Garage
(4)
(5)
I
_ _
-
(6)
(7)
(6)
Signature of Assessor
I
Other improvements
Total improvements (line 4 through line 6)
Total value (line 3 plus line 7)
I hereby certify the above is true, correct, and
complete.
I
Verifying action - Signature of Auditor
,.
.._` 'a "r..St.: _';-- :i<' °--= :: -.'i ?'i --.. -. STANDARD. DEDUCTION A.
20 _ Pay 20 _
Lesser of 112 Homestead
valuation or 535.000
S
Signature of Auditor Date igned O
i � #AA.A oA l - �T �a s