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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / S92)
INSTRUCTIONS: See reverse
❑ Have a beneficial interest in the eniiry that is liable for the property taxes on ihe property and that owns the propefiy'�o�is buving{�{�Qp,r a contract.
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CONTRACT RECORDED � ` : /
If buying on conVact, Fee Simple owners name �!Y�7�;.<_.�c�,vV
GIBSOta �-.•. � .: c,C�D!?: 3 �
. Recordefs oKCe where contrect is recorded Fecord number Page
PROPERTY DESCRIPTION �
Counry . Township Tawng disirict (ciry, to �n, mv ship
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mDerO�("�� Legaldescrip" /� � ^ �
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If any ponion of Ihe residential structure or ihe land not exceeding e(1) acre that m etliatety s ounds truaure is used to produce income, tlescribe Ne use antl ponion ot
the properry u6lized to produce incrome.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Tovmship Counry Tawnship
Sign�e ot la"�ryani
ereby certify the above statements are true, correct and complete. —3F� � ���'
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Address (numberand s1reeC ciry, state, ZIP mde)
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ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD � NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediatety (��
surrounding resideniial improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 Ihrough fine 6J (7)
Total value Qine 3 plus line 7) (8)
I hereby certify the above is true, toneCt, and Sgnawre of Assesor Date signed I
complete.
Ventying action - SignaWre of Autlitor Date signed
� STANDARD DEDUCTION ALLOWANCE �
19_ Pay 19 _
Lesser of 1/2 Homestead S
Valuation or 52,000 _
Signature ol Auditor Date signed