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CLAIM FOR HOMESTEAD PROPERTY TAX WEB YEAR CREDIT /STANDARD DEDUCTION
State Forth 5673 (R8/ 7 -07) 1 Prescribed by the Department of Local Govemmenl Finance 1" 0J
INSTRUCTIONS: See reverse side for riling instructions.
I (we) 4YT f ewe c• °� (lot � /( y� J OIBSON COUNTY AUDI7o2 —
(�� 7 certify that on the 1st day of March. 20
I (We) occupied as our principal place of residence the following described real props or which a Homestead Property Tax Credit is hereby claimed:
•
r'r (We) owned ❑ Are buying under contract
lave 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 ••r r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY
County Township Taxing district (city, tom, township)
Paul number Legal description I Is the property in question:
❑ Real property ❑ Mobile (tome (IC 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately wnounds that structure is used to produce income, describe the use and portion
of the property ubfiied to produce income.
a /o - 13 -07o - ,(o 3 - Do% l8 /- o o�l
ASSESSORUSEONLY
PROPERTY
County Township
County Township
I hereby certify the above statements are true, correct and complete.
.;fifri of claimant
-as (number and west, city, suite, and LP code)
r 1 c/ ci
ASSESSORUSEONLY
STANDARD DEDUCTION
ALLOWANCE
?7_ pay 20 _
45,000 for 2007 pay 2008
42,000 for 2010 pay 2011
Lesser of 1/2
Homestead Valuation
44,000 for 2008 pay 2009
Land not exceeding I(one) acre immediately
S
Of
43,000 for 2009 pay 2010
: -' "f=ry- .' -'-•
surrounding residential improvements.
(1)
; - -
Other lend
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
-
Assessed Mobile / Manufactured Home
.
Garage
(6)
- -
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 Assessor
Date signed (month, day. year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day. year)
STANDARD DEDUCTION
ALLOWANCE
?7_ pay 20 _
45,000 for 2007 pay 2008
42,000 for 2010 pay 2011
Lesser of 1/2
Homestead Valuation
44,000 for 2008 pay 2009
41,000 for 2011 pay 2012
S
Of
43,000 for 2009 pay 2010
40,000 payable after 2012
Signature of Auditor
Date signed (month, day. year)