HomeMy WebLinkAboutHomestead_CashCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
r State Form 5473 (R215-92)
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6
INSTRUCTIONS., See reverse side for filing instructions.
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CERTIFICATION STATEMENT
I (We) /1,1 certify that oNtt to 1 st da- of arch, 19_
I (We) occupied as our principal place of residence the follow' d ad real property for which a rr es ad _Property..T r reby claimed:
❑ I (We) owned ❑ Are buying under contract - GIBSON C;"', TY 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.
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
- PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township)
Parcel number
W5If)nqgq
Legal description
I ny portion of the residential structure or the Land not exceeds one (1) acre that immediately surrounds that structure is used to prcfduce income, describe the use and portion of
the property utilized to produce income.
/
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Sign tur fd ' nl A
-
iereby certify the above statements are true, correct and complete.
dd s�jnuZer and -Tt, city, fe, ZI cgQ t
/C �h.3 iS0
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOMESTEAD
NON - RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
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 Assesor
Date signed
complete.
verifying action - Signature of Auditor Date signed
®I STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
S
Valuation or 52,000
Signature of Auditor
Date signed