Homestead_Williams (12)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HCto
Sate Form 5473 (R7I sal
P.-ewibed by the Department of Local Governawt Foanoe
INSTRUCTIONS: See reverse side for Tiling instructions.
I _ CERTIFICATION STATEMENT NOv 2 1 zoub _
I (We) L/ r,C/ LYJ e �// �/%3ril certify the 1 of March, 20_
1,.._�jj(((,,,W���e..,,,) occupied as our principal pla , of residence the fallowing described real property for which a Homestead =;c I hereby claimed:
.y(We)ownned ❑ Are uyvFg under ce,rtm t GIBSON COUNTY AUDITOR
F`G` 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-
.. CONTRACT-RECORDED:.'. - -
If buycg on uantracl Fee Simple owners name
Fbxx"Ws office where cordrad is recorded Record number Page
- - - - - . PROPERTYDESCRMPTION -. -
Canty
Township
Taring d. . fownsfxp)
Panrxl rxmmar
L .
Is this in question:
Q -Iry 6 V
(nwrbsr and street afy, stall. LP code)
Amity ❑ M.W. H. (LC. 61.1 -7)
ff an y portion d the residential strucasa or th lard eeeedirg ore (1) ace OW m surrounds that is used to prod" ewnme. describe the use and portion
dt(h �/.�popent)' utilized to proouce'<mm�e. 1�
UY
aG i�i� �3r -CM 679 - X7
PROPERTY OWNED! BY CLAIMANT IN OTHER COUNTIES •. ,.
County
Township
County
Township
I hereby certify the above staternents are We, cared and canplete.
of
OF TTV
(nwrbsr and street afy, stall. LP code)
USE ONLY;
.' TRUE .TAX
ASSESSED VALUE
HOMESTEAD
`NON2E$IDENTIAL= •.• ,
'
- :ASSESSOR
- .ATI00Y.
OF TTV
.'' VALUE .
' VALUE j .•.
Land not exceeding 1 (one) acre immeda"
-
srarou ndi g residential improvernents.
Other land
(2)
. _ • _
Trial land (line 1 phis Mme 2)
(3)
Residential'vnprovements or Annually
Dwelling
(4)
Assessed Mobile I Mamilarhacd Home
Garage
(5)
Other improvements
I (6)
Total 'unpFovemends (fare 4 through fine 6)
(7)
--
Total value (fore 3 plus Gne 7)
(S)
1 hereby certify the above is t rue, cared, and
Signaure of Assessor
Date si7rned
cor plete.
Wifyhg edim - Signature of Audimr - --' —
Data signed
20 _ Pay 20 —
Lesser of 12 Homestead
Valuation or $35,000
signature of Pa&tor
STANDARD
DARD
S