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?4 : CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
` �J State Fwm 5473 (RS / 10�01)
"" Presaibed by lhe Department of Loca1 Govemment Finance
INSTRUCTIONS: See reverse side for lilipg instructions.
FORM YEAR ;
HC10 J
� � �
I(VJe) � _�( [y/ certify at on the tst day f arch, 20-7^
I(We) occupi d s our pnncipal place of residence lhe following described real property tor which a Homestead r erty T edit ereby imB :
❑ I(VJe) ov ed ❑ Are buying under contracl GIBSON C UN�Y AUDITOR
�Have a beneficial interest in the entity that is liable for the property taxes on the property and Ihat owns the property or is buying under a conVact.
ti=;_i.��-.i'jrs'�.r :?.� ee:; -- '.CONTRACT'RECORDED�_i.- � t�'�'�'.. . – :��'� - � -
If buying on contrad, Fee Simple owners name^
Recorders office where conVaa is recorded Rewrd number Page
County
Tawnship
�ar n r Le I CescnD�ion Is Ihe
� -� �'�.� 5 Nw 16-�-i o
I( any portion of lhe residenGal shucture w ihe land not exceeding one (1) arle t�al immetli�ly�urrounds
of the property utilized to produce inwme. � / qy, _
al pmPerry ❑ 6Wbile Hwno (l.4 G7.7-7)
is used to produce income, describe the use and porlan
.�����'�,�, AS§ESSOR USE ONLY ' � ; `� `~ � �� s2TRUE.TAX Y � �ASSESSED�VALUE �� -HOMESTEAD , �,� °� NON�-RESIDENTIAL�' ;�;
�,..'.�. �4. . t3�.'�.. .,��_�b 3. ,f.`;t �VALUE: AT100%OF'TN . VALl1Er`�' ....,' � VALUE�: ,�r,�,�.�.
Land not exceeding 1 (one) acre immediately `` � �x��i ° ,. -� *e�r" '
wrtounding residential improvements. (�� �` � .., t�^�= " --� ?''�:�:-
�,,,•
Other land (2� y� -, .e:�
}. ..:?
Total land (line 7 plus line 2) (3)
- i�- tt�Lr . qrc �'
Dwelling (4� J' {4µ���'a'tf-s°i'u%���.;'
Residential improvemenis -T" Y" �". - �" '� ' �' �
:���. y�, h� �.n x �, ,,.�,�� •
Garage (5) �.�,sqr'�"-��� ti�,��'-'
`: �c.:rF:��=1":`�.:--x-..,af, .�..-�..
Otherimprovements-• (6) = �����`^'_
"GF s Y
Tdal improvemenls (line 4 fhrough line 6) (7)
TUaI value (line 3 phs line n (g)
I hereby certify �he above is We, cortect, and Signawre otassesmr oa�e signed
complete.
Verifying action - Signa Wre of Autlilor Date signed
20_Pay20_
Lesser of 1l2 Homestead
Valualion or $6,000
SynaWre oflwditw .�
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