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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor filing instructions_
FORM YEAR
Hcia �'"'
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CE TIFICATION ME T �
�Ne) "l ' t at on the 1 t d q�f March, 19
�JJe) occupied as our principal pl of residence [he following described real prop or which a Homesteatl r T e it ereby ai
❑ I(We) owned ❑ Are buying under contract � GIBSOM1 CGUNT`! AUDfiOR
❑ Have a beneficiat interest in the entiry 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 contract, Fee Simple ownefs name ,
Recordefs office where contract is recortled . Recortl num6er Page
PROPERTY DESCRIPTI -
Coun Township Ta�cin 'ct ( , 1own. ship)
ar I n�umber �� � Leg description ' � � � — � _/ � / � �
C� S-0� �-
N any portion of ihe residential siruMUre or Ne lantl not exceediig one (7 ) acre immediatety sunounds that sWC[ure is used to produce income, tlescribe Ne use antl poNon of
the pmOertY utilizetl to protluce income.
�o - �o -0`1� -0?00- �XXJ 107�- Q�-/
PROPERTY OWNED BY CLAIMANT IN OTHEfl COUNTRIES
Counry Tovmship . , County Township
Siqp3turqofcla'unant
I hereby certity the above statements are true, correct and complete. X� � "� �
�dress (number a� street, uty, sfale, ZIP code)
t�/ ,�,. � �.7 .
ASSESSOR USE ONLY � TRUE TAX 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 improvements
Garage (5)
Oiher improvemenis (6)
Total improvements (line 4 through line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby Certity the above is tNe, correct, and SgnaWre of Assesor Date signed
complete.
Veritying action - Sigrature of Autliror Date signeC
STANDARD DEDUCTION ALLOWANCE
� 79_ Pay 79 _ -
Lesser of 7/2 Homestead �
aluation or 52,000
� na o Autlitor Datp�sgnyd _�� j� /
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