HomeMy WebLinkAboutHomestead_BatesCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
r State Form 5473 (112 15-92)
'e
,s INSTRUCTIONS: See reverse side for fling instructions.
FORM YEAR
HC10
` LED
• CERTIFICATION STATEMENT -
1 (We) - /'certify that on the, 1st day of March, 19_
(We) occupied as our principal place of residence the following described real property for which a Ho /stead Prop T redirt is re claimed:
❑ I (We) owned ❑ Are buying under contract �IBSON COUNTY AUDITOR
❑ Have a beneficial interest in the entity that is liable for the prop6rty taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded -
Record number
Page
PROPERTY DESCRIPTION
Court
Township
Taxing di "ct ( iy, town, shi )
arcel number
Legal description
3 -o a
If arty potion of the residential structure or the land not exceeding one ) acre that i ediatey suffolinds that structure is used to produce in me, de be the use and portion of
the property utilized to produce income. -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township County
Township
Signature of claimant
ereby certify the above statements are true, correct and complete.
Address (number and streel, ay, state. ZIP code)
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON- RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
-
Other improvements
(6)
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 Assesor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date signed