Homestead_Phillips (7)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEOR
CREDIT /STANDARD DEDUCTION HC10
Sate Forth 5473 (RS 17 -07)
,. Prescribed try da Department of Local Government Finance �Y T
INSTRUCTIONS: See reverse side for filing instructions.
I (We) al r ce*#,iat8n %e2A991ay of March, 20_
I (We) occupied as r prfnapal place of residence the following d bed real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
_l Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr his gepper a contract.
GIBSON COUf4,
CONTRACT RECORDED
If buying on oontraM Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County i Township i Taxing district (city, town, township)
C-1449-IN �/� ^^ Legal description Is the property m question:
- om U 4 -/'j(J - ( ❑ Real property ❑ Mobile Home (IC r, 1. 1 -7)
o arty portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
aF the property utilized to produce income.
ASSESSOR
20 pay 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
VALUE
I HOMESTEAD.
NON-RESIDENTIAL
Homestead Valuation
or 43,000 for 2009 pay 2010 40,000 payable after 2012
. _ .
.
Dala signed (7th. day, year)
j
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (lime 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
` °r`- '= `rs;'; r- :..•:.l . •`
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
_ =
Total improvements (line 4 through fine 6)
(7)
Total value (line 3 plus fine 7)
(8)
1 hereby Certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of motor
Date signed (month, day. year)
STANDARD r
20 pay 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
3
Homestead Valuation
or 43,000 for 2009 pay 2010 40,000 payable after 2012
. _ .
Signature of Auditor
Dala signed (7th. day, year)
j
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