Homestead_Schoonoverday cop
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
YEAR {
'CERTIFICATION STATEMENT
I lWel certify that on the 1 st day of March, 20
I (W)
occu&ra, #dVincipal ace of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ l(We)owned ❑ Are buying under contract
LeHave 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.
CONTRACT- RECORDED ft-., -
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'-P.kCIP.ERTY-.OWNElJ BY CLAIMANT IN OTHER- COUNTIES '-'��--.f7.J�,*�,—
County
'ASSESSED VALUE
Township
county —Township
County
Township
W
Taxing district (city, town, townshIrl
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&
s the property in question:
NO Yj Lrb,., ZOUZ(lc
'A'n-
surrounding residential improvements.
onset property 10 ome . . 6.,.1-7)
If any portion of the residential structure or the Land not exceeding one (1) acre that immediately surrounds that structure is on
produce in me scribe the use and portion
of the property utilized to produce income.
Other land
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GIBSON COUW1 AUDITOR I
'-P.kCIP.ERTY-.OWNElJ BY CLAIMANT IN OTHER- COUNTIES '-'��--.f7.J�,*�,—
County
'ASSESSED VALUE
Township
county —Township
I hereby certify the above statements are true, correct and complete.
Si ature of claiman'
� ) a R. Ir
W
be e street city
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20 _ Pay 20_
Lesser of 1t2 Homestead
Valuation or $6,000
S
Signature of Auditor I AC-1 n w A I ) -rA • . . . 0-0 V I UaTT-'�. V -
'ASSESSED VALUE
- --HOMESTEAD;,�
r6-jNON-RESIDENTIAL x
h47;,---
LJE.,� :6.1-�
,100% OF.Tly.,�
.AT -- 1-1
VALLIEKIZ41
-,
,VALUE .
Land not exceeding 1 (one) acre immediately
'A'n-
surrounding residential improvements.
k R4 A
Other land
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(2)
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
01 -.4r-
--t
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus 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 $6,000
S
Signature of Auditor I AC-1 n w A I ) -rA • . . . 0-0 V I UaTT-'�. V -