HomeMy WebLinkAboutHomestead_NievesCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Deparhnem of LoralCaovernrnent Finance FIL
INSTRUCTIONS: See rawrao ai de lint for moluctiorm
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ERT1F A NSTATEMENTKi+.' �S`� Z�' •-'S >, <� �: ::- „_ ....�_,. -F� <�Ky, ::
I (We) certify that on the 1st day of March, 20
I (We) occupied as our principal ce of residence the following described real property for which a Homestead P, s hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract GIgSON 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.
1OP060 '�" . ,riy- f'��CONTRACT;RECORDED3'p< .`''' 5, �* <i?. '3'-'' x';•t" •'�'"'.2" -
It buying on contract, Fee Simple ownees name
Recorders otfico where contract is recorded Record number Page
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I hereby certify the above statements are true, wired and complete.
Township
Taxing dis ' ( ytoki,townshipj
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property ❑Mobile Roma (LC. 67.1 -7)
If any portion of the residential structure or the land not exceeding one (1) sae that inunediatety surrounds'hat s cture is used to produce income. describe the use and portion
of the property utif¢ed to produce income.
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County Township
County Township
I hereby certify the above statements are true, wired and complete.
a re of claimant
d (number and t, city, stare, ZlP code)
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TRUEITAX U-7
�VALUEj�r,
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ASp ESSED VALUE
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HOMESTEAD
NON RRESIDENTIA
�ATx700 %.OFen
,F!°+'�'', VALUE ''.wY.-
s.'::..VALUE- '..°`Y''.e
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
2
Total land (line I plus line 2)
(3)
I
WO-
'Residential Improvements w Annually
Dwelling
(4)
At7settsed Mobile I Manufactured Home
Garage
(5)
Other improvements
—
Total improvements (li
�•
O•
To value (line 3plm Drawer N ......
tal
1 hereby certify the atx
Date signed
complete. Card NO ......................
verifying action - Signatur•
Date sy ned