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CREDIT/STANDARD CLAIM FOR TDEDUCTION
PROPERTY TAX
h State Form 5473 (R2 / 5-92)
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
FILE
CERTIFICATION etTENW
I (We) that on th is y of M h,
I (We) occupied as our principal pl of residence the followin d scri d real r ra Homeste i cl ' ad:
❑ I (We) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
CONTRACT RECORDED '
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION
Coun
Township
Taxing district (city, , towns )
number
009S F-0b
Legal de cripiion -
a - , q-o
If any potion of the residential structure or the land note eding one (1) acre at immediately sunounds that structure is used to produce income, describe the use and potion of
the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township County
Township
Signature o aiman
�reby certify the above statements are true, correct and complete.
dress d street, city, state, ZIP code)
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON- RESIDENTIAL
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
11)
-
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assesor
Date signed
Verifying action - Signature of Auditor
Date signetl
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19
Lesser of 1/2 Homestead
Valu [ion or $2,000
S
Signatur of itor
Date Sig ad