HomeMy WebLinkAboutHomestead_CouchCLAIM FOR HOMESTEAD PROPERTY TAX F YEAR —
CREDIT/STANDARD DEDUCTION Hcto
State Form 5473 (R5110-01)
1 11
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
-.'CERTIFICATION STATEMENT-,
I (We) lVdh4M J/ -( C �&� -0 f r7 (LUj�� _certify that on r1p lst day of
I (We) occupied as our principal place of residence the following described real property for which a Homestead Properlppi,(Qredbs)
l(We)owned ❑ Are buying under contract /O GIBSON COUNTY �Ij()Jj
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.'ft-,;m,� -','1-- t
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
OkOVERTY 6WNE6 BY CaIMANT IN-OTHEk-rodwits
�;PROPidaYbESCRIRTIdN ::`-:z _
County
Tomnshi,
County
T naw g district (city, town, township)
Parcel number
L I de t
VALUE
Is the property in question:
I) QJ-6-1Y -3 -31-
7y WD /' '3-
❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- �0 -,)0
surrounding residential improvements.
OkOVERTY 6WNE6 BY CaIMANT IN-OTHEk-rodwits
-"`-
County
Tmnship
County
Township
I hereby certify the above statements are true, correct and complete.
Sig 7 t of I
cz
VALUE
dress (nu e4nd s7 ZtalZ
ASSESSOR USE
-"`-
tot
YE-
AT I 00%-dFTTV;
VALUE
Signature of Auditor
Date signed
,
Land not exceeding I (one) acre immediately
...... .
surrounding residential improvements.
(1)
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
"®R",
Other improvements
(6)
S,
Total improvements (fine 4 through line 6)
(7)
1
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
19�7,4LA40 STANDARD.DEDUCTION ALLOWANCE
20 _ Pay 20_
Lesser of 1/2 Homestead
Valuation or 56,000
Signature of Auditor
Date signed