HomeMy WebLinkAboutHomestead_EwingCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Proscribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
---CERT1 T! STATEMENT CERTIFICATION STA MENT
FORM tYEAR]
NO
�fyjapttthe 1st day M .20
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Y,
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e
(We)
) E ipal f den e following described real property for which a Home a re
1W pied as as.., pntn. ��, aher y claimed:
❑ I (We) owned ❑ Ar igrAng under contract
IHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pMARY 2 Aaw nder a contract.
If buying on contract, Fee Simple owners name GIBSON COUNTY AUDITOR
Recorder's office where contract is recorded I Record number I Page
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County
Tmmship
Taxing district (city, town, township)
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Legal description
Is the property in question:
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6(n,
❑ Real property ❑ Mobile Homo (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1 i ace that immediatety wrrounds that sornIcitire is used to produce income, describe the use and portion
of the property utilized to produce income.
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County Township
County ITcomship,
I hereby certify the above statements are true, correct and complete..
gnatu
I
I ant
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0 1 1dress (number and street, city, ty, state, Zip code)
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TRUE -.TAX'
ASSESSED VALUE
KIHOMESTEAD
!NOWRESidhT&�W
VA�UEL
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Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
'Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARDMEDUCTION ALLOWANCE--r-'-
20 — Pay 20_
Lesser of 112 Homestead
Valuation or $35.000
Signature of Auditor Date signed