Homestead_Green (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDITISTANDARD DEDUCTION HC10
State Form 5473 IRS 11"1)
Prescribed by the Department of Local Government Imance —
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INSTRUCTIONS: See inverse sale for riling instructions. (ADS' IL F n
buying under coritract
GIBSON COUNTY ApaTr
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ift 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 u r a contract.
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NTRACTE
'RECORDED
If buying on contract, Fee Simple owners name
Recorder's office where contact is recorded Record number Page
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WRAwasso—W
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County
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Parcel nu bar
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Land not exceeding I (one) acre immediately
Is the property iryquestion:
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is
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Real property U Mobile Home (LC. 6 .1. 1-7)
N my portion of the residential structure or the land note inp one (1) acre that immid I I
ftl stirichine is used to produce income, describe the u" and portion
of the property utilized to prochioa income.
Mmsumunds
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County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Si ture a nt
ni ss (number and sonaer, dry, dry, state, ZIP code)
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TRUETAX
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?HOMESTEAD
11 9 PTEAD
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Land not exceeding I (one) acre immediately
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surrounding residential Improvements.
(1)
Other land
(2)
N. ' PA
EWE K W.
Total land (fine I plus line 2)
(3)
'My" PIZ
Dwelling
(4)
Wr
Residential improvements
Garage
(5)
Other improvements
(6)
r
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
6ARUDEDUC ON"ALILOWANCE QM05m
20 _ Pay 20_
Lesser of 112 Homestead $
Valuation or $6,000
Signature of Auditor Date signed