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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fofm 5473 (R2 / S92)
INSTRUCTIONS: See reverse side for (iling instrucfions.
FORM
HC10
YEAR
CERTIFICATION STATEMENT
a• �'
I(We) �$�� st Aay of March, 19_
I(We) occupied as our principal place of residence ihe follovring described real property for which a Ho � t a roF ��,fiereby claimed:
❑ I(We) owned ❑ Are buying under coniract
❑ Have a beneficial interest in the entity that is liable for the properry tazes on Ihe property and that own�l� Prc�(,�y �ying under a contract.
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� CONTRACTRECORDED / `._%
Ii buying on convact, Fee Simple owners name -�/"J°` '
GIBSON CU!1�1TY hUDITOR I
Recordefs ottice where contract is recortled Record number Page
PROPERTY DESCRIPTION
Counry Township Tazing Cistrici (ciry. town, township)
Parcel number Legal descnpGOn
(o -C9o? 33 -
It any portion of ihe residential structure or ihe lantl not ezceeding one (7 ) acre ihat imm ' ey surtounds th t s[mcture is used [o protluce income. tlescribe Ne use antl portion of
Ne properry util¢ed to produce inmme.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
CounTy TOwnShip Counry Township
�gnature of aimant �
ereby certify the above statements are true, correct and complete.
P,�yrg num randstreet,ciry,sfafe�IPOOde) � �� �
l c� i o l n nv<�..r3���: �iv U
SESSOR USE ONLY TRUETAX .ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� � �
surrounding residential improvemenis.
Otherland (2)
Total land (line 7 plus line 2) (3)
� Dwelling (4)
Residential improvements
Garage (5) .
Other improvements (6)
Total improvemenis Qine 4 through line 6) (7) .
Tota� value (line 3 plus line 7) (8)
1 hereby certify the above is true, correct, and Signawre of Assesor Daie signetl
complete.
Verifying action - SgnaWre of Auditor Date signed
�� STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser of 7/2 Homestead $
Valuation or 52.000
Signature of Auditor � Date signed �^-
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