HomeMy WebLinkAboutHomestead_Lee (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
CREDIT/STANDARD DEDUCTION HC10
State Fonn 5473 (11715-M T ''1177--��
prescribed by Me Depmtrnenl d Loral Government Feanco
INSTRUCUONS: See reverse side for fifarg msirucdpns.
"X <m . " .' - - CA'nON STATEMENT. -
4
1 (We) certify drat on the 1st day of Mardi, 2D_
I (We) occupied as our principal of the following described real property for which a Homestead Pmt hereby claimed:
jjQ We
I () owned F-1 Am buying u con6ad GIBSON COUNTY AUDITOR
70Have a lereticial bderest m the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
- - • CONTRACT IR OIWIIW
If buysg on mnbsl. Fee Simple owner's nape
Racordees oltco where corbae m receded Pacord number Page
• -
- . � •� -- PROPERTY DESCRIPTION'.'
Township
County
Tawn Wip
Tamg district (dy, town, '
Parcel number
Legs desuiptim
ta the property in question:
— _40)_ M0.
pr-00
property ❑ Mobile Hama (LC. 1.1- .
11 arty perbon d the resK*nb l sbuc9se m the Imd nal emeecing ono (1) ate Mat imrerial ely amour that sb6cliere is used to proGce iwome, describe the u4vtriii pertion
of the property ulif®d to produce income.
'- .f2`r " " r )t > YW'r,
:..:::PROPEIiTY OVYlIED'BYCLADIANTw OTHER COUNTffS " . - Iasi
County
Township
County
Towrnship
I hereby certify the above statements are true, correct and complete.
at daunal
.
(number ad sheet city. state. ZIP code) t
wESi €:
W1 3:39 r L:nc 1 I
A).
Valuation or E35.0D0
— Ir
x . ` UE ONLY
ASS` ESSOR
'ME.TM
SESSD VAILUg
VALUE
- STAL� ,j
VALUE
Lesser of 12 Homestead
wESi €:
Land not exceeding 1 (one) am imnedately
Valuation or E35.0D0
'- .f2`r " " r )t > YW'r,
srmowding residential improvements.
(1)
y $� .IZ "iS`; 'rib . ,?i rWs 'at
Other land
(2)
Torsi land (Ice 1 p6ms Ere 2)
(3)
��
(4)
nproveents or Annually
Residential "v m
+�r ry:...ar,'.Y
Assessed Mobile f Manufactured Home
rag a
yNF V 5r}'*y i
(5)
Other onprovenents
(6)
Trial urprove girds (fore 4 through Ere 6)
m
Total value (fore 3 pks Iine 7)
(g)
1 hereby certity the above is true, tared, and
Complete -
3®reLae dyer
Date signed
%A& yirg action - Sgebse of Auditor
Data signed
STANDARD DEDUCTION ALLOWANCE d
20 _ Pay 2O _
Lesser of 12 Homestead
E
Valuation or E35.0D0
d
Date 3 O�
k n