HomeMy WebLinkAboutHomestead_DilbeckCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
Sbft Fonn 5473 (R7 / SM
Prescribed by to Depititinent of Local GoverrmirA France
INSTRUCTIONS: See reverss side for Ong instructions. F1 D
:CERT1IFICATMSTATENE?ff_
1 (we) �—A�A/MA-^V certify that on the 1 st day of March. 20
1 (We) occupied as our principal place of residence the following described real property for which a Homestead ProCoAt"reby damed:
I-0 1 (V&-) owned ❑ Are buybV under contract GIBSON 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.
C0NT1;tACTzRECOIRDED,,r
tf buying on mnbarx Fee Smilile owners narms
Rmorder's office where Contract m recorded Pecard number Page
7 PROPERTY DIIESCRIPTIOW
County
Canty
Tomnshp
T ' istrict (Cmlj� lawn. townshp)
xxwll�
I hereby certify the above statements are true, correct and cornplele.
Parcel
Leo dei�criptian
Is the properly in question:
nw
Poid properly
❑ M.Ni. Herne (m r
If any portion of the reaKerejal struchue or the land not exceeding ore (1) im:re that intireclatitly sunounds that abucture is used to prod" ina>,re, doom" the um and portion
of the Wwffty W&md W produce
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'OFidPERTYdWNtdi3YCUWA"tDi'dtiiEit'CdUWhES',,,.
County
Timnship
County
Tmnship
I hereby certify the above statements are true, correct and cornplele.
Signature of dairnand
( number and street ciA; sftpt% ZP -do)
STMDAFW DEDUCTION ALLOIAMCE U -
,
.
- fHOl1ff.S1EAD
t ,
Lasser of 12 Horrestead
ATAOWCW,
3 4VALUE�
nw
,.
Land not exceeding I (one) acre invnediately
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suffoundirV residential inVrovernents-
Other land
(2)
Total land (I've 1 pka line 2)
(3)
Dwe lling
A
Residential snprovernents or Annually
(4)
,
, 7 N
Assessed Mobile I Manufactured Horne
Garage
V,-V.. 37
M
(5)
40
,
Other mpovernents
(6)
Tdal irnprovennents (rare 4 through Em 6)
(7)
Trial value (1kie 3 phs Em 7)
(8)
1 hereby certify the above is true, ccffecL and
SignshffecfAssessor
Date signed
complete.
Verifying action - SUnature of Auchir
Date signed
STMDAFW DEDUCTION ALLOIAMCE U -
20_Pay2O_
Lasser of 12 Horrestead
Valuation or MODO
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