HomeMy WebLinkAboutHomestead_Shoultz (9)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
i CREDIT /STANDARD DEDUCTION HC10
State Forth 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing insVUctions. -W1 g W' 'r--n ylr---,
I (We) 'f Ltyg:x. certify tho (1TtheZt sl dnoarch, 20
,11((We)e) occupied as principal place esidence the following described a property for which a Homestead Property Tax Credit is hereby claimed:
1H -f me) owned ❑ Are buying under contract Q, // //
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns operiy or s buying and d- c61 /ntract.
GBSON COUNT r AUDITOR 1
?CONTRACVRECORDEO -�"'X '3,'` vin °�4`�ii.? • ' `�'{^;' = �':.°`y
It buying on contract. Fee Simple owner's name
Recorder's office wham contract is recorded Record number Page
����lt' 4' ��' ��i�FS '4^- wurP,ROP,ERTY<DESCRIPTION�' --" � a -
County
ToNrlship
Taxing district (dory, toown, township) ,
hereby certify the above statements are true, correct and complete.
Signat of claiman
J
G[ rA-
Parcel nu/m'�ber //�1
Lmud
description
Is the property, in ti :
V c) /
—'
Real property ❑ Mobile Home (I-C. 6-1.1 -7)
If any portion of the residential sbucWre or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
v<3�$"r"?E
County
Township
County Township
hereby certify the above statements are true, correct and complete.
Signat of claiman
Addre ss (n bar and street, city, st�atye ZIP code) _
S 7� /3 �/a n -'j-
ONLY` '
aTRUE TA)C
' .4 e
ASSESSEDVAWE
•ry
HOMESTEAD'S
x il NON= RESIDENTUIL -
7ASSESSOWUSE t
} E
e
.SAT 700%O a V&
>•:
w xy VALUE FIZ
l�VAL'
.traVALUE��y .
kt�r- dY.,,M ....w.� -.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
Y•`
o.
(2)w
i e
TctW land (line 1 plus line 2)
(3)
Dwelling
(4
)'-_
l:x.,s"
�`"`
Residential Improvements or Annually
Assessed Madre / Manufactured Hoare
Garage
(5)
i' "
•, :.. �"--s
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
�`>• �? +y "0_ Pay 20 , S` '-•.STAN DARDMEDUCTION'ALLOWANCEt`
.. � ..m �*".e�s`.x� fYlkY..11�4A1 firZ.°+'AtiZ.a` 1��1x:r=2
20 _Pay 20
Lesser of 112 Homestead
$
vauaaon or 536.000
Signature of Auditor Date signed