HomeMy WebLinkAboutHomestead_LunnCLAIM FOR HOMESTEAD PROPERTY T AX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling Instructions. I L
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I (W) certify that c��sl ddayf rch, 20
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I (W:) occupie a our principal piece of residence the following described real property for which a Homestead Prope by claimed:
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(We)owned ❑ Are buying under contract GMSON COUNTY AuDiron
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.
P
,.--&1,,CONTRACT- RECORDED
If buying W contract. Fee Simple owners name
Recorders office where contract Is recorded Retard number Page
PROP. ERTY:OMED•BYtCL:AJMANT,fWOTHER-COUNTIES---k. 'l-
F!kbPERT�YtdESCRIPTION'��-,!;,''r
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County
Tomiship
Taxing dis
Signature of claimant
ress (number and street, city, state, ZIP code)
Parcel number
Legal description
Is the property in puestion:
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'C>�Mperty ❑ Mobile Home (I.C. 61.1-7)
If any portion of the residential structure or the land not exceeding we (1) am that immediately surrounds the structure is used to produce income. describe the use and portion
of the property utilized to produce income.
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PROP. ERTY:OMED•BYtCL:AJMANT,fWOTHER-COUNTIES---k. 'l-
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
ress (number and street, city, state, ZIP code)
NINE
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ASSESSE-0-VALLIE
J,Y HOMESTEAD-'-
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-'7-�-,,'t�NON-RESIDENTIALI-i�;-- i,
Lesser of V2 Homestead
Valuation or $35,000
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y ,Q�VALLJE.V��
Land not exceeding 1 (one) acre immediately
Signature ofAutiltor
Date signed
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surrounding residential Improvements.
Other land
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4)
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Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5
improvements
(6)
'her
Trial Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor R Ilk
Date signed
AL
STANDARD.DEDUC, OWALL
20 Pay 20
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Lesser of V2 Homestead
Valuation or $35,000
IdIr?
AUDITOR
Signature ofAutiltor
Date signed