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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92) � g�
A
FORM
Cio
YEAR
INSTRUCTIONS: See reverse side or �ling inshudi n �� ),�A� � �L,J b� �� .
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FICATION STATEMENT �
I(We) ert hat on e 1 day of March, 19_
I(VJe) occupied a u r ipal place � e the follovring described real properry tor dit is hereby claimed:
� GIBSON COUNT A �
❑ I(We) owned ❑ Are buying under contract �
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and thai owns the property or is buying under a contract.
CONTRACTRECORDED � -
If buying on contracl, Fee Simple ownefs name
Recorder's otfice where contract is recorded � Recnrd number Page
PROPERTV DESCRIPTION
Counry Township Ta�cing tlisirict (ciry, town, fownship) �
Parcel number Legal tlescnplion
-Q�O S -OO 3
If any ponion o( Ue resitlential structure or ihe lantl not exceetling one ( cre that immediately sunounds ihat sWCNre is used to pro uce income, tlescnbe the use antl portion of
ihe properry utilaetl to produce income.
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� � PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry . Township
S nature ot dairnant
. ereby certify the above statements are true, correct and complete. ��
Address (number antl streeG ciry, stafe, ZIP wUe)
ASSESSOR USE ONLY TRUE TAX . ASSESSED HOMESTEAD � NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatery (� �
surrounding residential improvements.
Otherland (2)
Total land (Iine 7 plus line 2) (3)
Dwelling (4) .
Residential improvements
Garage (5) -
Other improvements (6)
Total improvements (line 4 through line 6) (7) .
Total value (line 3 plus line 7) (8)
I hereby certify the above is trUe, coveCt, and � � Signature ot Assesor � Date signed
complete.
Verityinq ac6on - Signamre of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead $
Valuation or $2,000
Sgnawre ot Audi:or \ Date signed -
Lti/ � D