Homestead_Riley (3)s..,E o
e �.,; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
i' State Forth 5473 (8215-92)
0 _ f
INSTRUCTIONS: See reverse side for filing instructions.
FORM
HC10
FILED
YEAR
CERTIFICATION STATEMENT
JAN! 7 2001
I (We) _ certify that on th 1 st day of March, 19_
1 (We) occupied as our principal place of residence the oll ng described real property for which a mestead Pr e ax Cre is eby claimed:
❑ I (We) owned El Are buying under contract GIBSRN COUNTY A�IDITOR
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns t e property or Is trying under a contract.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
County
Township
Taxing district , t wit, t ip)
Parcel n //qp��eer ��-yy��
L� -003(00- W
Legal description
/—'
1
If any portion of the residential structure or the land not exceeding one (1) acre Mat immediately surrounds lh mcture is used to produce income, scribe the use and portion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
Count'
Township
ereby certify the above statements are true, correct
and complete.
Si lure ofd 'mast
umber and street, dry. state, ZIP code)
ASSESSOR USE ONLY
ffLand
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE
exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
Total land (line 1 plus line 2)
(3)
-
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed .
Verifying action - Signature of Autlitor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valuat n or 52,000
S
Signature cl Audi r
Date signed
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