HomeMy WebLinkAboutHomestead_Harris (2)CLAIM FOR HOMESTEAD PROPERTY TAX
_rt ?; STANDARD / SUPPLEMENTAL DEDUCTION
Staie Form 5473 (R7216-09)
�� � PrauribEd by Ihe DepaNrent of Local Government Franca
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INSTRUCTIONS: See raverse side !or filirg instnictions. "
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I(We) %U � certify Nat I(we) occupied as my (our) principal
place of idence or am (are) buying the foliowi desaibed real properry tw which a Homestead Property 7ax Sianda�peducti �'� reb�daimed
unde nVad on �he date Ihis appliralion is fil , (date o/filing): - X�Q�
� �„e) � CiIBSON COUNTY AUOITOR
❑ Am (are) buyirg under rewrded wnVad �
❑ Am (are) entitled to occupy as a tenant-stockholder ot a coopereUve housing corporetion .
� Have a beneficial interest in the Wst or the right to occupy the property under ihe terms of a qualified personal residence Wst
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Narne of t (legal name)/ , �
�C�J
' mm8a af tla'vrent (bsf fi�e di�E OrneYS ficerue / IGrntiflplion / Issumg
/� d daimant (WSt five digiGS)
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Name of nPs pousa ( ' ,
$acial S numbrl imant's spouse (l�Jast five d+gGS) Drive(s Gce�ae / Identificatirn / ONer number�+�
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II buying on contra4 Fee Simple ownefs �me ,
ReooNels ofice where contreG is reooided ' � Record numbu Page
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Counry s ` Township Tamg Eis '(rill: Mwn ownahi ) '
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Pa�cel number Leg destnP� Is Ihe P�Perty m qu�tion:
� ���E �� 3��3� � Real P�Pe+�Y ❑ AnnwOy assessed rta6ile home (IC 6f. f-7)
II any po ' iha rasden�al sWCW�a w �he land not axreed4ig are (1 � aae that Immadiatety surmu Os Nat sbuGUre Is use0 to p�oduce incmre. Eesrnbe the use and portion
o��,a� ��,�3� . /90 �-
��-/� .���O�o.�.��aG9
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Cowriy TownShip Counry � TownsNp � � "
I hereby certiy the above ststements are true, corted and complete. Signaw ot imam � C�� �
PGdress (number and straet, dry, stete, antl ZIP cade) . •
� �— - _ C�� 5 ��n S-t . . c.�,� b s ac� + � �t-1 ��3 �7�
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Land not exceeding 1(one) acm immediatety " f +fi �+?.�3'�.� -" .r;?
surtoundin resldential im rovemen�. �» ����'=�.�� n�����
s ��'� ,�
Otherland (2) ;"+�,''�F� -1? �
r. ° s «
Total land Qine 1 plus line 2) (3) y
y,.�..�.e.� �'�;I2`�-� rwr �`�°.:
Residential improvemenb orMnuaily �����9 ��) ��t �c'�i�'"s:,,iF$§ir` 4e Z'.ir��
Assessetl Mobik / ManWacWred Home ��'��`�� '�3`�.� �.{y
Garage (5) Cs��$^rx 4'�'..`i-€���"�:SS,:7:. _
� Y' wU��#�3
Otherimproveme� (6) ' F���;�:1�,�;?:"
Tatal impmvementa (Ilne I fhrougA line � (7) � '
7otal value (Ilne 7 p/is lfne � (8)
I hereby Certify the above is W e, cortect, SigraGire af Assessor �a[e Wgned (mmlh, day, yea�,
and complete.
Varifyin9 ac6on - SignaWre of Auditor Date signed (rtronN, day, yea�
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20 _ pay 20 Lesser ot 60% of the assessed value o(1he homestead or 545,000 �
NolwitM1VeMUg eny ofherprovis'an, Ne aum o/ lhe deductions pro�.dtletl in IC frf. f-7Y to a mob�h fame Na( a $ �
not essessed as real properry a Io a menulaUUred home Ne� a not assessed es ieal properry may not exceed �
oneJUX (121 NNe assessed valueW Ne mobde hwna ormanularlure0 farna.
Sig�ature o(lu�dlfnr , Date si9neE (monM. deY. YT��