HomeMy WebLinkAboutHomestead_ScalesFORM YEAR
IFICATION STATEMENT
CEITr_ qFp 7no?
I (We) th
P; n the ,1st des
,,offirdh 20 qe
T
I (We) occupied as principal place of res�8�e o 6wing described real property for which a Homestead Pr F/o T I I
OF3
❑ l(We)owned ❑ Are buying under contract GIBSON COUK4 i Y AUDI�T
0 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.
'ICONTRACT! RECORDED_;�
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
--PROPERTY
CLAIM FOR HOMESTEAD PROPERTY TAX
County
CREDIT/STANDARD DEDUCTION
County
State Form 5473 (R5110 -01)
Township
Prescribed by the Department of Local Government Finance
I wns ip)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
IFICATION STATEMENT
CEITr_ qFp 7no?
I (We) th
P; n the ,1st des
,,offirdh 20 qe
T
I (We) occupied as principal place of res�8�e o 6wing described real property for which a Homestead Pr F/o T I I
OF3
❑ l(We)owned ❑ Are buying under contract GIBSON COUK4 i Y AUDI�T
0 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.
'ICONTRACT! RECORDED_;�
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
--PROPERTY
"�14
County
DESCRI0.TION-'-
County
Coun
Township
Taxing district (city,
I wns ip)
P
,A!cel number
Le
1 Y�Vtoa
��
Is the pro pkyj
question
Mq3 ov -OD
Land not exceeding I (one) acre immediately
�Iw
Real property Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that sActaie
is used to produce describe the use and portion
of the property utilized to produce income.
4'A0K6PEkTy_.'6WNEIJ BY cLAimANT IN OTHEWCOUNTIES�'
"�14
County
Township
County
�!T�ASSESSOR USE ONLY,, r, -: - "� .
Township
I hereby certify the above statements are true, correct and complete.
Si nature .mant
6- AL
" dre ber and street, city, state, ZIP code)
`L-Z Z W- M , r 1� 1) 1-
1AJ
17640
STANDARD.DEDUCTIONALLOWANCE'-'�-'�.'
-TAX
ASSESSED VALUE
�HOMESTEA6
NON -RESIDENTIAL �hfikQ�-'f-,
�!T�ASSESSOR USE ONLY,, r, -: - "� .
VALUE
AT100 0 TTW
% F
VALUE%-'
6- AL
h.
Date signed
Land not exceeding I (one) acre immediately
surrounding residential improvements.
7
Other land
(2)
t.
Total land (line I plus line 2)
(3)
W
Dwelling
(4)
Residential improvements
Garage
Other improvements
(6)
ti
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
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD.DEDUCTIONALLOWANCE'-'�-'�.'
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $6.000
Signet e of Auditor
Signal
jovy j
Date signed