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i � CLAIM FOR HOMESTEAD PROPERTY TAX
���i i CREDIT/STANDARD DEDUCTION
�� Sta;e Form 5a73 (R2 / 5�92)
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INSTRUCTIONS: See reverse 5ide for liling inst�uctions.
FORM YEAR
O • 4 . >��
� .'�.. ~- ".'��.. . .
:� 1 ti 1995
IS„L��l %.0 l�t�(].�,Q` � certify that on iheA��y�rch.-19./`
as our principal place of residence the following described real pmpeny for which a Homestead Pmperty Tax Credit is hereby daimed:
�I (We) owned ❑ Are buying under con(raq
❑ Have a bene!icial interest in ihe entiry that is liable for the propeny taxes on �he property and that owns the property or is buying under a contract.
CONTRACTRECORDED
If buying om m�tracL Fee Simple owner'S name
Recorder's oM�ce where comract is remrtletl Recortl number I Page
Counry
Township
Legal tlescrip�ion
I: any ponion ot the residential stmcmre or �he land not
ol ihe property utilized ro produce income.
PROPERTV DESCRIPTION
fown,
�
one (�1 acre that immed�a;ety surmunds thai stmcmre is usetl m protluce income, tlescribe the use and portion
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES �
Counry Township Coun�y Tmvnship
�-eby cenity the above statements are true, correci and complete. S�gnaw�e claimant
Atldress (numbe� and s7reef. city. state. ZIP code)
� _ saa ��
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediately I( � I I
surwunding residential improvements.
Otherland �p) I I
Total land (line 7 plus line 2� (3) I
Dwelling I (d)
Residential imprOVemenis
Garage (5�
Other improvement5 (6) I
Total improvement5 (line 4 Ih�ough line � (7) I I
Total value (line 3 p�s line 7� (g)
I hereby certify the above is �me. correCi. and Signa;ure of Assessor I Daie signetl
complete.
�ying aclion - Signamre of Autliror Da;e sfgnetl
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Gibson County Auditor
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