HomeMy WebLinkAboutHomestead_GreenCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Foan 5173 (R614-03)
Presalbed by the Department of Local Caeverrm ent Finance
INSTRUCTIONS: See feaarailf aldo IbrEhtp kn&L dorm
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FORM
HC10
L E
YEAR
I (We) ' VPl certify that on the Ist day of March, 20_
1 (We) o pied as our principal pla of residence the following described real property for which a Homestead PropertyJax Credit 'hereby claimed'
❑ I (We) owned ❑ Are buying under contract �a� N
GIBSON COUNTY 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.
•° - -- s� ts-o.. ONTRACTe RECORDED
'.i�.l> bat'' �. �.,. rr'' �. s�-''<: p" �' �� •'�c�d36c��°ar�'.'�.rt�g'�Ts,..
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
.s"'= ':''tr?- ..R.�." PROP.ERTY;OWNED'BV CLAIMAHT;IN
County Township
County
Tavnship
Taring district (city, town, township)
P /j��cel number e(/U/ C/'�o�
�G1I
al d '0 IS-3-5
Is the property in question:
V Y 7
❑ Real property ❑ Mobile Homo (W. &1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) aae that immediately surrounds that structure is used to produce income. desoribe the use and portion
of the property udl¢ed to produce income.
Ava;LL A-do aal.7a'41- O/
.s"'= ':''tr?- ..R.�." PROP.ERTY;OWNED'BV CLAIMAHT;IN
County Township
County Township
h r y certify the above statements are true, correct and complete.
J
Signature of claimant
n ' (num(L and street city, state ZlP code)
YACUE,F�ATi100wA'OF,TTV
IL
STANDARD.DEDUCTION'ALLOINANCE ;'� -29,
20 _ Pay 20
Lesser of 1r2 Homestead $
Valuation or 535.000
Signature of Audta Date signed
TRUETAXm
ASSESSED VALUE
SHOMESTEADtn'
NONE- '� >(
YACUE,F�ATi100wA'OF,TTV
✓.w
VALUE
.wr
�RESIDENTU\L
'-zr, VALUE u�
'w.vrh4ti, w w.7r
Land not exceeding t (one) acre immediately
(t)
'%¢,ti`tl' i•m l5lrvd..I
surroundin residential improvements.
yam.
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
-
Asatettaed MoblJe I Manufactured Herne
Garage
5
()
;c# - : r'-:.
MINE
aS ia}{i_
Other improvements
Total improvements (line 4 through fine 6)
(7)
Total value (line 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD.DEDUCTION'ALLOINANCE ;'� -29,
20 _ Pay 20
Lesser of 1r2 Homestead $
Valuation or 535.000
Signature of Audta Date signed