Homestead_Dyern.
CLAIM FOR HOMESTEAD PROPERN TAX
CREDIT/STANDARD DEDUCTION
State Fwm 5473 (R8 /4-03)
Prescribed by Ne Departrnem W Local Govemment Finance
INSTRUCTIONS: See reverse side Ior �ling insfructions.
FORM YEAR
HC10
� �
I(We) W /' certify that on�e 1st d� of rch. 20
I(We) occupied as our princ al piace of reside ce the foll 'ng descnbed real property (or which a� omestead� per�a[ Credit' reby daimed:
✓
❑ I(We) owned ❑ Are buying under contract GiBSON CJOUNTY i.UDITOR
, Have a benefidal interest in the entity that is liable for the property ta�ces on the properry and that owns the property or is buying under a wnVaU.
II buying on conVad, Fee Simple ownefs name
ofice where contracl is
Twmship
Racord number
r w' J-1 J� � I L��OtI� � /�' 03�t4e prope OnReuaelswu : //
a-«� 3/ 3 � �
a� ❑ �b��e
H eny poNOn o1 Me residentiel aW ctura w Ne land not excaeEinp one (1 J aae Nat immediatety surtounds �hat sWGUre ia used b praduce income. i
M the DroPe+h uLT¢eC to praduce income.
��- /% � /- T�� �OQU. �/- 0�/
'���'�"���=.'2-��;!�? --?F��`•".�r.��pROPERTY;ONINED.BY:C1:Alkt.>NT-:IN;OTFiEFiCOUNTIES'}t�.:�,j'.��r_`,�?;;�t�.
County Township County Twvnship
1 hereby certify the above statements are We, correct and complete.
I u(num a 56eet, city, te, ZIP code) Q � �
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