HomeMy WebLinkAboutHomestead_Coomer (3)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8614 -03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See rewm aide for ow ffah cdom
F1FORM /t YEAR
g �L rHC10 "._..- I„
MAR 0 6
I (We) ��,Q� Lrl�l..l�iefrf --- j / / y�� GIBSON.CGUNTY AUDIT ay
cart that T the 1st day of March, 20_
1 (We) occupied as our principal place of sidence ollowing described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
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.
•'- ��"+iKCONiR7iCT.' RECORDED, s��s�? ��i, t •�- �,''ir��i- .."'�i�'.- 7,���.'
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
:`-.' .'�:�>"�r"-t:E�r',���x�r'^�`��.
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a'�.- �- c- �^'3»�4'.=;y`?. P,ROPERTY<DESCRIPTIONt . n' a-'' y, �' ��„£ r�°. ''"'',x- �ix,.:.:�•�����y�.�;^ =�
County
Toxnship
County Township
Taxing district (city, town, township)
P r
I be TT
'S-�V
d
criptlon
Is the property in question:
.�
El Real property ❑ Mobile Homo (LC. bf. 1-7)
If any portion of the residential structure or the40TVof
ce mg one 7'aae at imme is ty surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
..:;ia1«:�.. ,�m�,n��
- r- .�PROP.ERTY,OWNED''BY CLAIM,CNi.IN S�Z"'fi'�«
County
HOMESTEAD e :
Twvnship
County Township
I hereby certify the above statements are true, correct and complete.
i re lai
jdre r s
ate, ZIP e)
Land not exceeding 1 (one) acre immediately
°l / //
�Ta ,„ a'
ASSESSORNSE ONLY=
: TRUE,TAX�
}S.
ASSESSED VALUE
w
HOMESTEAD e :
�tNON= RESIDENTIAL rib
Rte.,=
--
�.VALUE`.�g,
A T 100 %.OF='TTVA
�7;VALUE
i�VALUEq,:. ,
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
• �"
ti
Other land
(2)
yt
EN
Total land (fine 1 plus line 2)
(3)
'Residential
Dwelling
•,t,yj,q /t w
` v0
K �
Improvements or Annually
Assessed Mobile I Manufactured Harm
Garage
(5)
Other improvements
(6)''`
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
, -' "STANDAR6. DEDUC1ION' ALL OWANCE;j
20_Pay 20_
Lesser of 1/2 Homestead
valuation or (35.000
Signature of Auditor Date signed