HomeMy WebLinkAboutHomestead_Dortch0 V, CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Stale Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instmclions.
M
FORM YEAR
HC70
FILED
I (We) 4 1 C�� /N�%�U� L,/�— certify that on the 1st day of March, 20
I (We) occupied as our principal place of residence the following described real property for which a HortPrax Credit is hereby claimed:
I (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 contract.
ONTRACT.'REC_O_R_DED
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
^='r� _ .•- ?"- �'. >... -.- .._.r>'N� >. `.,,n -,wm'� .: t: r�- ::PROPERTY.DESCRIP,TION'+ -�r2�:
�..� ... s='.'- '- '�w'u[W.-v!T,'°;'
County
Tomship
Taxing district (city, town
Twvnship
Par��
at descdption
fire pro
/F-
in question:
property ❑ Mobile Homo (I.C. 6.1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immedi ely sufrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
T�� .�`z,�'''.ix, s -'��h� �� °' • -'�`.� `:w'f PROP,ERTY,OWNEU'BY CLAIMANT INOTFIER "COUNTIES €�,�,.��'�
�x'�a}f^�r.„'�,1,'."y� = '<t- 5�.%:,e''fi�! �.- '�li`a
County
Township
County
Twvnship
1 hereby certify the above statements are true, correct and complete.
Si nature of claimant
4�(/O
dress (number and street, city, state, ZIP code)
3�a S1ree, 104 k, 4� - Al 66
4 }gSSESSOR'USE ONLYA'^{`
i TRUETAX+
ASSESSEDVAL`UE
._
HOMESTEAD
R
NONitESIDENTIAL s+
'{
aATt100 %OF�TfY
,VALUE..
tc'k.$j,VALUE.:'3t'
Land not exceeding 1 (one) acre immediately`,�s
y"1-
surrounding residential improvements.
.� V�'tz- .",-__ t,
Otherland
cN? T AM
Total land (line 1 plus line 2)
(3)
Dwelling
(4)_,G�.a^,>
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
Other improvements
(6)
HIM
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
- :,•.^- ".°@',ctm"'rY��' -T,i`. STANDARD! DEDUCTION' AL'' LOWANCE„` ,`*3n,>�.,-x'`�,;,..z>::'?'.°r�
20 _ Pay 20
Lesser of 11`2 Homestead 5
valuation 535.000
Signature of Ar Date sign
-�3�