HomeMy WebLinkAboutHomestead_GossettCLAIWFOR HOMESTEAD P* ROPERTY TAX �, FORM YEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS 14-0)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side forming instructions. FIL
CERTIFICATIO STATEP AYVKWZUU-tI-
I (we) "ify th the 1st day ofMarch,'20—
I (We) occupied as our principal place of residence the following described real property for which a Credit Is hereby claimed:
F] I (We) owned ❑ 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.
2,CONTRACTRECORIDEID� �g
If W09 on contract Fee Simple owner's name
Recorders office where contract is recorded Record number Page
9�:'% t��-*-N.iPROPERTY.,OWNED'.B*.CLAIM4NT.ItiOTHEF;CCOUNTIESx;5t!,',i-" ,-,'
"k,-, -PFiOFi-ERTYtOESCkIPT]bi4K4!�tT,��",;,-ft��T,
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County
Township
Taxing district (ody, town, township)
Basel
number
�a I ��A the property in question:
❑ Real pmperty ❑ Mobile Home (LC. 6-1.1-7)
�(I),= 0.1,11
'n
If any portion of the FestrIentiad structure or the I of exceeding . th�.ti,.Imwy� 1 Structure is used to produce income, describe the use and portion
of the property utilized to produce income.
9�:'% t��-*-N.iPROPERTY.,OWNED'.B*.CLAIM4NT.ItiOTHEF;CCOUNTIESx;5t!,',i-" ,-,'
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
7 tu
617 q� rid street city o 21"A C�L4 V
Ll 1) A 11
R
-TRUE TAXI
X
NONAESIDENTIAL'.,,
VLUE-.i -
VALU -E
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
1 01 4,
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
V '5
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
?;belr improvements
(6)
-2.
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correcL and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed