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HomeMy WebLinkAboutHomestead_NeidigCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION State Form 5473 (RS 14-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for filing instructions. V YEAR _ED r ...... .,,., �':so,.- '- CERTIFICATION STATEMENT - -• :- %'lit -'V I (We) certify that on the 1 st day of March, 20 1 (We) occupied as our principal place of residence the following describ real property for which a Homestead Property T" jt 0#34W claimed: (We) owned ❑ Are buying under contract GIBSON 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 wntracl. rr�.''.i=as� -- :. �' >i�3.r;.,�- '..x��r�- �'t:�� —Y �, t' 5�' �a; :CONTR/1CTRECORDEDsCaa">:M1�a -t. 1i:, -� - 1$F�'�Sc's ��.°s- ...��s•�r z�'�tts.4- :' ?_.;,. ";:. If buying on contact, Fee Simple owner's name Recorder's office where contract is recorded Record number Page rW'ritir �.=< X�. St�re�`' �- 3PROPERTYUESCRIPTION -.?: -4 ...�..'—`�`- kzrc's£i'.�._._. tSa^ County llX Township Taring ' net (city, awn, fo sI// Parcel 1numbeerr'� .G,G /�_ /,c,y/ �/ D/: V — QD / / / 'ri0 Leg d sc' lion — t� �� Is the props in question ( Real property ❑ Mobile Home( LC. 6-1.1 -7) If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that swcture is used to produce income, describe the use and portion of thethe any r¢ed to produce income. -da -0/ aoa -cam. 5 'Xix Land not exceeding 1 (one) acre immediately'. ��t.?:' s: �' k' stE�' ��;.'. ��;-` �`€.; T�• i5 %k����.�P,ROP.ERTY.OWNED`:.BY County Township County Township hereby certify the above statements are We, correct and complete. Signature of claimant dress (number and street, city, state, ZIP code) rys 4-)��`y.K �++.`f?��4'"' +<T Tr}s"h• t�' ASSESSOR USE RUE TAX r 3 ASSESSED VALUE. "' &HOMESTEAD F NO N-RES'fDENTWL ' e -„(z++ -�� -5... _'mac- NOR eF..? AT 100 /e OF;TTV" ::VALUE o , VALUE Land not exceeding 1 (one) acre immediately'. �F.j. surrounding residential improvements. 11)x''•��x'.,r -0t Other land Trial land (line 1 plus line 2) (3) Dwelling (4) (Residential improvements or Annually Assessed Motile /Manufactured Home Garage (5) r Tom, ,� 3t�j.� <,,• � } ;��' s! �` Other improvements (6) •^�i- aW --A DTs NOT, •Y� 1�J VL :° < i Trial improvements (line 4 through line 6) (T) Total value (line 3 plus line 7) (6) hereby certify the above is We, correct, and Signature of Assessor Date signed complete. _ Verifying action - Signature of Auditor Date signed TANDARDDEDUCTIONALLOWANCE � �>.'71 S`-�arrvs�L'�= -v . ogg ' 2 Pay 200 Lesser of 112 Homestead $ Valuation or 835.000 Sigma ra o1 Date signed u