HomeMy WebLinkAboutHomestead_FetcherCIAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
State Fortn Sr73 (R6l L-03)
PresvibeE by Me Depnrorront d Laxl CaovemmeM Finance
INS7RUCTiONS: See rovsrio ddo b IYnp ins6uctiy�s.
FORM �� YEAR
ct
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�(We) //�(.l.�liLAl(J�� J�� l Q�[li���� certify lhat'bwt e 1 t���pf March. 20
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I(We) occupied as our principal place of residence the following described real property for which a Homestead Property Credit� hergb� daimed:
� I(We) owned ❑ Are buying under coniract GIBSON COUNTY AUDITOR
, Have a benefidal interest in the entity that is liable for the property taxes on ihe property and Nat owns ihe property or is buying under a wntraU.
If buying on conVad, Fee Simple owners name
RemNefs ofice whme contraq is reoordetl
����`-��--"t'��rH�°'s��S�F�'•Et."�`Ss-^` F
County Tamship
Parcel number L descripGon
On�/-oo�Y99-c�� 1���
H any poNOn of Me resiEential sWCWre w Me land na a eeAi
ot ihe proPerty uWized b produce income.
County
Tavnship
district (dty,
Is Ne
ng one (1) ace ihat immediately wrrounds
�� �
I hereby certi(y Ihe above statemenls are We, corted and complete.
(nvmber and sfreet, ury, s(afe, ZIP crode)
Land not exceeding 1(one) acre immediatey
surtounding residential improvements.
Other land
TUaI land (line 1 plus line 2)
�Rasidential improvements orMnuaOy
As�essed hb61b / Marwfa�red Hane
Other improvements
Dwelling
Ga2ge
TUaI improvemenfs (line 4 through line 6)
Tdal value (line 3 plus line n
I hereby ceRify ihe above is We, corred, and
complete.
Verifyirg action - Signature oflwdiWr
(�1
�Z)
(3)
i4)
(5)
(6)
(�)
Ie)
SignaNre ofASSessor
County
Record number
Page
I LL� v�operty ❑ MoMla Hwno (I.C. 67.7-n
swGUre is used b Droduce inmme, tlesaibe Me uu and ponion
signed
Date signed
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20 _ Pay 20 _
Lesser of t/2 Homestead
vawaum a f35.000 §
Signawre of Aud"rtor " Date signeA