HomeMy WebLinkAboutHomestead_Doerner (6)F�
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CLAIM FOR HOMESTEAD PROPERTY TAX
STANDARD / SUPPLEMENTAL DEDUCTION
State Form 5473 (R1215-09)
Prescribed by the Department of Loral Govemrnem Finarxe
INSTRUCTIONS: See reverse side for fifug instructions.
FORM YEAR
HC10
FILED
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CERTIFICATION STATEMENT
I (We) certify that I (we) occupied as my (our) principal
place of residence or am (are) buying the following described real property for which a Homestead Property Tax Standard Deduction is hereby claimed
under contract on the date this application is filed, (date of filing):
❑ I (We) own ❑ Am (are) buying under recorded contract
❑ Am (are) entitled to occupy as atenant- stockholder of a cooperative housing corporation GIBSON COUNTY AUDITOR
Have a beneficial interest In the trust or the right to occupy the property under the terms of a qualified personal residence trust
INFORMATION
Name of da ant('_ al na
Social Senmry
��• VVV
Name of dairant's s (1 aainame)
Social Security numbed
Issueg Sate
IV
• RECORDED
H buYin9 on mntracL Fee Simple ownees came
Recrmels ofice where Conuact is recorded
Record number Page
PROPERTY DESCRIPTION
my
Township
Taxing district (city, ti a, ') ,
Pip/ /1 numbbarr a('. /'��
(o ccD
Legal description
Q..) -00 /
Is the pent' in question:
I!r cmt/ I
I property ❑ Annually assessed ma We home (IC 6.1.1 -7)
If any portion of the residential structure or the land not exceeding orre (1) acre that Immediately surrOUrbS that structure is used to produce Incene, describe the use and portion
of the property utilized to produce income.
1: B
County (�� r� "- I County Townstup
A
As AA A
I hereby certify the abovt L -5 "atu
Address (number and street
to ti�ls3 E — 6 J r HOMESTEAD NON-RESIDENTIAL
VALUE AT 100% OF TTV VALUE VALUE
Land not exceeding 1 (or.;'1-== }i;�
^;�,:F
surrounding residential iI
,,�...��c.,
Otherland :- Nrj�+.l�1.1�.
Total land (line 1 plus lins W�l
�rNIN
Residential Improvement!
Assessed Mobile I Manufa ! etc: r-,1 �j `•�=,F-YSy:3r;5
Other improvements `.'+ -`"
Total Improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct,
Signature of Assessor
Data signed (month, day, year)
and complete.
Verifying action - Signature of motor
Data signed (nronlh, day, year)
STANDARD • r
20 pay 20 Lesser of 60% of the assessed value of the homestead or $45,000
&W&VItsrani ing any ol6erprevYSBn, the stun of the deductions pre Wad in IC 6- 1.1 -12 to a mo6de hone that is
$
not assessed as real property or to a nantadured home that is rot assessed as roal property may not exceed
of the assessed de home orrnanufadurred home.
(
Date ad (coon
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