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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / 5-92)
INSTRUCTIONS See reverse side foi filina instructions.
FORM
HC10
YEAR
. CERTIFICATION T EMENT
/ � L�.a.�J Y1 �` D � \
I(We) , �'7 S / �i � ertify that on Ath�Q�st�auof March, 19_
I(We) occupied as our principal place of residence the foilowing described real property for which a Homestead Property Vat � ean ish�Q�claimed:
❑ I(We) owned ❑ Are buying under contract �
❑ Have a beneficial interest in the entiry that is liatile for the propeRy taues on the property and thai owns the pr r's � u r a co ct.
�IBSON COUNTY AUD�T
CONTRACTRECORDED �
It buying on convact, Fee Simple ownefs name
Recorders oHice where conVact is recorded Record number Page
� PROPERTY DESCRIPTION
Counry r�^ To ip Tacing tli (ciry, fown, wnship)
��/ � ( •
Parcel umber Legal descripti
Q �� 0
If any portion of the residenGal sWCNre or the land not ezceeding one (t) acre that immetliatey surrountls Nai structure is usetl to produce income, tlescnbe the use and portion of
the pmperry u6lized to Droduce incrome.
-/�/� a�-a�� 0 9a- a�-� -
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Signat re clai nt
�ereby certify the above statements are true, correct and complete.
Addre mpeiarrtlstre ciry,stafe,➢PCOde) � '
���3 3 �
- ASSESSOR USE ONLY TRUETAX � ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� � . �
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvemenis
Garage (5)
Other improvements (6)
Tofal improvements (line 4 through line 6) (7) "
Total value (line 3 plus line 7J .(8)
I hereby certify ihe above is true, conect, and Signamre of assesor oate signed
complete.
Verifying action - Signature oi Auditor Date signed
STANDARD DEDUCTION ALLOWANCE - �
19_ y 19 _
Lesse f 1/2'Homestead S
V uati r S2, �oo
Sgnamre of Auditor Date si
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