HomeMy WebLinkAboutHomestead_Starnes,� sT�rF 4
: �„ CLAIM FOR HOMESTEAD PROPERTY TAX
;�
` CREDIT/STANDARD DEDUCTION
•.,�`/' State Fortn 5473 (R2 / S92) .
16
INSTRUCTIONS: See ieverse side for liling instructions.
FORM � YEAR
HC10 �
C RT FICATION STATEMENT
I(We) certify that on ihe 7 st day of March, 19_
I(We) oc�up�E� as our ri ipal place of residence the tollowing described real property for which a Homestead Property Tax Credit is he y d:
-E�'I �e) owned Are buying under contract
�' Have a beneficial inierest in Ihe entiry fhat is liable for the property taxes on the property and Ihat owns the prop�r�b �n .
JL'
� CONTRACT RECORDED -
If buying on contrect, Fee Simple ownets name
RecorOers office where contraci is recoNed
GIBSON CGUP'.TY AUD �
PROPERTY DESCRIPTION
Counry Tovmship Taxin is ct � ry, town, �
a�n� ,o � 3 ` escnption
�J
If any portion oF the resitlential sWClure or Ihe land not exceeding one (i) acre that immetliatey surtountls thai sWCture is usetl to produce income, describe Ne use and poNon ot
Ne properry uuT¢ed to produce inoome. ,
�_�7 03- 00-o6/�a3-a�
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township � Counry Township
Signat � f daima t
I hereby certiry the above statements are true, correct and complete.
- Adtlre s(number a sfreel, ciry, s(ate, ZlP code)
I�� ��a o...�„�.��\1 ��N 4� 6 �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
_ nd not ezceeding 1(one) acre immediately �� �
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2J (3)
Dwelling (4)
Residential improvements
Garage (5) .
Other improvements (6)
Total improvemenis (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify Ne above is true, Conect, and Signa[ure of Awesor Date signed
compiete.
Ventying action - Signature of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of t/2 Hom stead
Valuation or ,000
�ature of Auditor Da' sRJhetl
- a-o