Homestead_Bender (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R6 / 403)
Prescribed by the Department of Local Government Finance
RUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
A
I (We)
certify that on the 1st day of March,120
I (We) occupied as our principal place of residence the following described real property for which a Homestead F'roperty,Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract � GIBSON COIJSI-i y "uj; i bn ,
lil 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�A-,,rT.-1,".��;-
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
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County
Cou
County
Tcwnship
Taxing districA
S' ure of
u er and r, city, state, ZlP Code)
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surrounding residential improvements.
Legal description
Is the pro p-v
I bon:
Other land
(2)
I
L)O-R-O Property ❑ Mobile Ha. 6.1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stkaure
is used to produce income, describe the use and portion
of the property utilized to produce income.
C> O'D
Total land (fine 1 plus line 2)
-�4 300
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County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
S' ure of
u er and r, city, state, ZlP Code)
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ASSESSED VALUE
AT
W HOMESTEAD
VALUE;11,�
-N IU�E rfdE�[A[ -2g,
-�Rvfj�
W,10 , OVALUE'E�
Land not exceeding 1 (one) acre immediately
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surrounding residential improvements.
Other land
(2)
OR
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
om-��*WO
Residential Improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20_
Lesser of 1/2 Homestead
ValualboA or $35.000
,— I —r —
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Date