Homestead_HempflingCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
j State Form 5473 (R614-031
Prescribed by the Department of Local Gmemmenl Finance
INSTRUCTIONS: See reverse side for filing instructions. -
I (We) I r r lyb atp the7_stda rch, 20_
I (We) occupied as our principal place r idence the following d cri d real prope or which a Horn d Pro rty T BrAdit he y daimed
❑ I (We) owned ❑ Are buyi der contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the orQpgny Oros 2M under a contract.
If buying on contract, Fee Simple owners name
office where contract is recorded
GI3SON CCOUI Ty
Record number I Page
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°' PROP,ERT.Y; DESCRIPTIONS .i.- ....�`+�`�'�1�� -�.
County
Tomship
ig ture of claimant
t
Taxing district (dry, town, township)
P ce mber ^^
it u
Legal deltCn pn �.,
. 'v\ h /�3411.XIQl?yl
'c` :VALUE.T
UEsa' `� a'3�
Is th property in question:
(� ❑ Real property ❑ Mobile Home (I.C. 61.1 -7)
H any portion of the residential structure or the land not exceeding one (1) acre
of the property utilized to produce income.
Nat immediately surrounds that structure is used to produce income, describe the use and portion
` PROP, ERTY: OWNEt WCLAI III INOTHERCOUNTIES'f.,. .,' ? r- `''"s -a a"g` .!'f's•''�° -s_'
County Township
County Township
l 1e by certify the above statements are true, correct and complete
ig ture of claimant
t
Iss (number and street, city, state, tZ�IP code)
V 1_�. A i ZLSI& A €)"% n AMA
A
r r ASSESS RUSE ON Y x' �"
�tTRUET�d( '�
�,��A
ASSESSED VALUE
�HOIdESTEAD `
-IN
N-RESIDENTIAL- p��+�i r`.?
ke :.:.. `G't`#' '.".�'it'°.r. z'1+:..�._
'�.aiV -AI:UE
100 /, OF}TfV -,Cs
'c` :VALUE.T
UEsa' `� a'3�
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
r e-
Total land (line 1 plus line 2)
(3)
=?-- v,, �tss.`7
Dwelling
(4)
W! R V"
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Gara a
9
5
O
'"� _ '
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
,
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD'.DE000TION' ALLOWANCE
20 _ Pay 20
Lesser of 112 Homestead
Vaiva on or 535.000
Sig ' m f Auditor Date sighed,
U i