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'��" CLAIM FOR HOMESTEAD PROPERTY TAX
;��� CREDIT/STANDARD DEDUCTION
��P Siate Form 5473 (R2 / 592)
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INSTRUCTIONS: See reverse srde /or /iling instructions. .
GIBSON COUNTY AUOITOR
CERTIFICATION STATEMENT
I(We) � certify that on the 7 si day of March, 19_
I(We) occupied as o pri i I place of resid e the following described real pr erty for which a Homestead Property Tan Credit is hereby claimed:
I(We) owned ❑ Are buying under contract �
Have a beneficial interest in the entiry that is liable for the property taues on the property and that owns the property or is buying under a coniract.
CONTRACTRECORDED
I( buying on contract, Fee Simpie owners name
Recortlels ottice where contract is recortletl _ Record number Page
PROPERTY DESCRIPTION �
Counry Township T'ng disirict (d town, township)
Parcel number - Legal tlescription
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If any poNon of ihe residential sWCture or Ne land not exceetling one (1) acre that immediatety surrounds thai sWqure is usetl ro protluce income, describe the use and portion of
the praperry utiGzed to O�uce incame.
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Sgnature ot a' nt
ereby certify the above statements are true, correct and complete.
Addre (num6er and street, ciry, stafe, ZIP cod J �
� /1 �� ef � � �tl �7D
- ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding residential improvements.
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4) .
Residential improvements
Garage (5) .
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby certify the above is We, correct, and Si9nawre of Pssesor Date signed �
complete.
Verirying actim - Signature of Auditor Date siqneC
STANDARD DEDUCTION ALLOWANCE �
19_ Pay 19 _
Lesser of 1/2 Homestead r�
Vatuation or 52,000 .
Sgnamre ot Autlttor Date signed