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(�LLAfM�OR HOMESTEAD PROPERTY TAX FORM YEAR
CREDITISTANDARD DEDUCTION " Hc�o 6 d/,
State Form 5473 (R6 / 403)
Prescribed by the Department of Local Govemment Finance r���
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INSTRUCTIONS: See ieverse side for filing insMictions.
' " CERTIFICATION STA'T�MENT
I(V1le) certify that on the 1st day of March, 20_
I( ) occupied as our principal place of residence following described real property for which a Homestead Property T��1is�� claimed:
i(We) owned ❑ Are buying under con ct �i C� �
GIBSOt� COUNTY AUDI'C'Of�
' Have a benefiaal interest in the entity that is liabie for the property taxes on the property and that owns the property or is buying under a contract.
If buying on contrect, Fee Simple owner's name
Recorders office where contract is recorded
County Tavnship
Parcel nu er Le I description
♦ -,� i
If any portion of the residentiat structure or the land not exceeding one (1) acre
of the property utilized to produce income.
�'����ir
T�cing
Is the pro,
surrounds that
County Township County
I hereby certify the above statements are true, correct and complete. Si9natw
qddress (number and street, city, sfate, Z1P code) �
�,, Ll 0 t� i• L✓9ePi�o �K /' a� r,v c F ro.�✓,
of daimant
�,n.
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Record number
Page
township)
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� question:
Real property ❑ Mobile Homo (1.C. &1.1-�
�ure is used to produce income, describe the use and portion
Township
,� 7 0
`" _ � ~�'�* � ,x ASSES�S;QR USE ON1Y �,- . _;7RUETAX ASSE�SED 1/ALUE ; t10ME�7'E�1D ` �QI�-REStQrENT1AL
� , ,..., ..�., .. �; ; . � .:.: w.:. YALUE . �� °; AT 100°/a OF"fTV �. � „ VAL11E , , ,,�'� rt `.,. � ��!�-UE �
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Land not exceeding 1(one) acre immediately ` ���?�� �� � •
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surrounding residential improvements. �� � ` �` ` �
Other land �Z�
Tdal land (line 1 pius line 2) �3�
r
Dwelling (4) �� � `�i� `���� �����, �� ;K
r����r ��
�Residential improvements or Annually ��� ��°���� �;�� < �
Assessed Mobile / Manufadured Home Garage �5� � �� �; ��� ��,���� �� �� �
�� : f .� � � ��:� �, �: F �
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Other improvements (g)
Tdal improvements (line 4 through line 6) ���
Tdai value (line 3 plu5line � �g�
I hereby certify the aboVe is true, correct, and Signature of Assessor Date signed
complete.
Verifying action - Signature of Auditor Date signed
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