Homestead_White (3)ry� � CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
5 f Sfate Fwm 5473 (R4 / 8-00)
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INSTRUCTIONS: See �ererse side (or filirg ins6vc6ons.
F�RM YEAR
�Hg1pJ
AUG 2 0 2001
�� GIBSOW COUt7TY AW��un �
I(1Ne) � d certi(y that on the tst day of March, 20_
I(We) occupied as our principal place of re' ce following described real property for which a Homestead Property Tac Credit is hereby davned:
❑ I(We) owned ❑ Are buying under contract
�ave a beneficial interest in Ne entiry that is liable for Ne property taxes on the property and that mvns the properry or is buying under a contrad.
It buyifg on contraU, Fee Simple ownefs name
Recorder's olfice where mntrad is recorded
County
Parcel num6er
cb,5 _ �
If any portion ol
of the D�operty t
TamsNp
-a� I �"f-' �(/� �
s WQure or the land rrot exceetling one (1 � ave
ice income. � �
Record numher Page ,
� CuNG (CI� fawnship)
7 �
�G - �-h? Sa� ,
surrounds Nat structure is usetl m pmduce inwme, desuibe the use aM portion
� -..3'�� -��,��"'�'�Y_°�,_:,�`�`�'��',,�STANDARD�DEDUCTIOMALL`01fVANCE����'��,;y�'��:.�_;;,�,��,�,{�xi�:�;:_�::i..�
20 _ Pay 20 _
Lesser of 12 Homestead
Valuatlon or 56,000 $
SignaWre of Fwditor Date signed
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