HomeMy WebLinkAboutHomestead_CarlisleCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
State Forth 5473 (RS/ 1D-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) cert' that on the 1 t d f Marc 20
I (We) occupied as our principal place of residence the following des a al property for which a Homes t Ptbp r r a ad
❑ I (We) owned ❑ Are buying under contract GIBBON CrOUNTY 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.
t�+§rst✓'- *`'�ska�r r; <CONTRACTRECORDED%�°'-
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If buying on contract, Fee Simple ownefs name
Recorder's office where contract is recorded Record number Page
FER7,Y:DESCRIPTION��'`�.
County
Township
Taxing district (city, town, township)
Pauxil n
L scri n
e9 P
Is the property in qtr on
{y
— g, 0. It
eat property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the Ian not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
C)3.3 - Cd
..-. xx c ROP,ERTY OWNED:BY.CL'AIMANT:IN.' OTHER` COUNTIES, b` p�t� `eir�i'�as,�.,,�,F?�F.,�-�`x
^County
a" ' ` tt*`�.i5_� 79Y �&
Tmnship
Count Twvnship
I hereby certify the above statements are true, correct and complete.
i ature of ai a
41e
Ile
A r (nu/tyer aM sires city st ZIP e
J A.*-M 16
rY--3
a" ' ` tt*`�.i5_� 79Y �&
rTRUEoTAX y
ASSESSED VALUE
>HOMESTEAD
sN0 ,RESIDENTIAL `
�'
. ' ARwwl aR��Ug'4r•E, NLY.
" yr VALUE "'
"AT 100 %'OFTTV
VALUEr"s -
'xFVALUE
tr d..- .,__.. �.
,�,...
do -.
Land not exceeding 1 (one) acre immediately
4
surrounding residential improvements.
1
"�`�'
Y
Other land
(2)
-V «
�n;� +3t�i� -i
Total land (line 1 plus line 2)
(3)
Ll
-y
Dwelling
(4)
.�JS.� ;5
NEW
Residential improvements
Garage
(5)
"-
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
i
' STANDARD:DEDUCTION ALLOWANCE
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Dat igned
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