HomeMy WebLinkAboutHomestead_GamblinCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
t -• Slate Form 5473 (R5/ 10-01)
°M Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
I (We) certify that on the 1st day of March, 20_
I (We pi sour principal place of esidence the following described real property for which a Homestead Propert``kyCrepiQs C oIH& claimed:
I (We) owned ❑ Are buying under contract /� ,1 /1
Have a beneficial al interest in the entity that is liable for the property taxes on the property and that owns the property or is.btAnng udder a contrat:Q
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3CONTRACTRECORDED
If buying on contract. Fee Simple ownees name
Recorder's office where contract is recorded Record number Page
��`�"'fd"��'�"�"t PROP. ERTY; OWNEDBY; CLAIMAHTeIN 'OTHER'COUNTIES,1,".¢;�i'� �„��,,.-- ��f`•!�
County
Township
Turing C ( wnship)
I u= _o V
L description Isthepropertyi ges'on:
property ❑ Mobile Homo (LC. 61.1 -7)
If any Portion of the residential structure or the land not ex ing one (1) acre that immediately surrounds that structure is used to produce income, describe the use and Portion
of the property utibm to produce income.
��`�"'fd"��'�"�"t PROP. ERTY; OWNEDBY; CLAIMAHTeIN 'OTHER'COUNTIES,1,".¢;�i'� �„��,,.-- ��f`•!�
County
Township
County Tmnship
NON;RESNENTWL
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- yALUE�
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I hereby certify the above statements are W e, correct and complete.
Signatur of at nt
Address mygr 1a M S(reel, * araf code) z( -7,� Q_ _
- s'+ "a (USE;
ASBESSOR�USE ONLY
TRUETAXYx 7r�
v'''"
ASSESSEOVACUE
HOlAESTFIID
`VALUEE%E
NON;RESNENTWL
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AT,�700 °k'OFTTV
VALUES -;
Land not exceeding 1 (one) acre immediately
g'
% -W
surrounding residential improvements.
Other land
(2)M-
?ss'aa
Total land (line 1 plus line 2)
(3)
Dwelling
(4)z
' +p- 4 rl
-,-
Residential improvements
Garage
t�
(5)
",�-
cK= .
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 We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
`[OWAICE .e
a h.v FOSTANDARDDEDUCTIONAL F
20_ Pay 20
Lesser of 112 Homestead
Valuation or $6,000 $
Signature of Audhor Date signed