Homestead_Phillips (8)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION Hcto
State Forth 5473 (R614-03)
1
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for
property for which a Homestead Property T�Crediti�- gereby claimed.
❑ I (We) owned ❑ Are buying under contract GOSON 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.
K=' "CONTRACrRECORDED'rsr .2. _r m 'j,u Y.�' a .i•--L,se �"ss; r'.,s If buying on contrail, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
P. ROP,ERTY OWNED- ;BYCLAIMANT,IN'`OTNERCOUNTIES
County
Township
Testing dis ' ci o hip)
Parcel be l�
L
sc ' n
Is the property in question:
S
J!< .w,..
surrounding residential improvements.
eat property Mobile Homo ( /.C. 6-1.1 -7)
an portion of the residential structure or the tan of ex eedi a, (1J aae at immediately surrounds that s cure is used to produce income, describe the use and portion
of the property utilized to produce income. /1 '%%G ° a 9�0
P. ROP,ERTY OWNED- ;BYCLAIMANT,IN'`OTNERCOUNTIES
6•-?C£:'L+tj;'j,.,`3_i!'ss"24
County
Township
County Township
hereby certify the above statements are true, correct and complete.
Si nature of claimant
�s s (number and street, city, state, ZIP code)
6
L�c7
l 'CS�+'•r,j , . .yT ir. ty,>" .�- �_.�.} 5
USE ONLY
'-
fi- :.w. Nom°
iTR.UE TA.
- -
AT, 100 %OTN.
AASSESSOR
i -
—NY • `
"� VALUE".T. UOED L0HOM
n ,. IDE
Land not exceeding 1 (one) acre immediately
J!< .w,..
surrounding residential improvements.
(1)
, #�AM
Other land
+•s
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
�Residen8el improvements or Annually
Assessed Motile /Manufactured Hama
Garage
(8)
improvements rovements
(6)
'- ���.''`' 3'1-x.
REOther
Total improvements (line 4 through line 6)
(T)
Total value (line 3 pits line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1t2 Homestead
valuation or 535.000
Date signeyv ` - &F -0