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� � CLAIM FOR HOMESTEAD PRORERTY TAX
" - :' CREDIT/STANDARD DEDUCTION
'� l State Fwm 5473 (R4 / B-00)
INSTRUCTIONS: See reverse side (or filing instruc6ons.
V
FORM �. <
HC10
GIBSON
3 2001 � �
/i i
I(We) C SS��,U .1�� ��AS �v .� ll� certify that on the 1st day of March, 20_
I(We) occupied as princi lace of residence Ne following described real property for which a Homestead�Property Tac Credit is hereby davned:
�I (We) owned ❑ Are buying under contrect
�ave a benefidal interest in lhe entity that is liable tor the property taxes on the property and that owns the property or is buying under a contrad.
II buyu�g on CAnNacL Fee Simple ownefs name
, - , ', _
Recordefs offKe where contrad is recorded � .,_ .
RecorO number Page
Counry Township Tacin9 � Iricl (cil}; (own, townshipJ .
Parcel number Qa�s Legal desaiptlon .- . ,
oq
I( atry pwtion ot the residential sW cture w the lantl not ezceetling one (t) ave Ihat immediatety surtounds Nat struUure is used to D�uce income, describe the use anE portion
of the WoPeM utilized lo P�uce i�mome. - - .. • . .
County
Twvnship �
I hereby certify the above statements are We, corred and complete.
p�dre�(nuyhe� ds e4 �iry�stat�e� n`��^ 0/
re
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County _
ToHnship
. .. � . ..... . r. . � .
20_Pay20_
Lesser ot 12 Homestead
Valuation or $6,000
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