Homestead_Thorne (2)D)
CLAIM FOR HOMESTEAD PROPERTY TAX s / WL YEAR
CREDIT /STANDARD DEDUCTION
State Proscribed y the (R6 / Department Reaaihed by tM Depertrrie+n rN Local Government Finaxe
INSTRUCT70NS. See reverco sklo far QV irmucoone.
n$•pCERTIFICAnoN
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I (We) certify that on the 1 st-day of March, 20
I (We) occupied as our principal p ce of residence the following described real property for which a Homestead Property Tax Credit is'hereby'datmed:
V V
e) owned ❑ Are buying under contract GIBSCN 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.
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If buying on contract, Fee Supple owners name
Recorders office where contract is recorded Record number Page
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FPROPERT.YxDESCRIPTION'tti''_; `'g�'ia"l.rya. i? 5-. '•y,� :L" ' ii0.iyf'y..r.�.
County
Township
Si at a of cfaimant
Taing district (d
own, ownsh' )
Parcel number
Leg I description
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Is the property i estion:
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— O ( - W
property ❑ Mobile Homo (l.C. 61. 1-7)
H any portion of the residential structure or the t1ind not exteding
of the op�lo produce income.
one (1) acre that immedia y surrounds that sbu ture is used to produce income, describe the use air portion
- , V— PROP.ERTY;OWNEU'.BY OL'AIMANT;IN;OTHER'COUNTIES t., �' z,"x, 4w` .rt-i '� 'r:' a
County Township
County Township
I hereby certify the above statements are We, correct and complete.
Si at a of cfaimant
Address (number and street, city, state, ZIP code)
6 'nz''#�� r1•�*..52�.rr a
?'- 4ASSESSOR�USE ONLY
- TRUE TAX mss?
_ * , ;T
;,VALUE h,y -
ASSESSED VALUE
., ATt100 °A OFTfV
`` HOMESTEAD
av".
,;.VALUE'
o �AE
NON RESIOEHTI/1LaA
�„'?'3VALUE x
Land not exceeding 1 (one) acre immediately
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surrounding residential improvements.
Other land
(2)
2?
Total land (line 1 plus line 2)
(3)
Dwelling
(4)y
-«,,,
'Residential Improvements Annualty
or
Assessed Mdit / ManufachLred Harm
Garage
(5)
Other improvements
(6)
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Trial improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed