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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sute Form 5473 (RB / 403)
Presaibed by the Department o( local Govemmem Pinance
INSTRUCTIONS: See reverse side lor filing inslrucfions.
FORM YEAR
HC10
� � J i J � �
1(We) I/ /VOU? Y���YI O�-f � QJ� Ul, I V y LUUJ
certifylhat on the 1sl da �of March, 20
,I...(�W,�e) occupied as our pri al place of residence Ihe following descnbed real property for which a Homeste Property T re ''s here d ed:
L�f I(We) owned ❑ Are buying under wntracl /i���""�``! i1
GIBSON COU Tti' AUDITOR
� Have a benefidal inlerest in the entity ihat is liable (or the property taxes on ihe property and ihat owns the property or is buying under a contraU.
If buylnq on conirdq. Fee Simple owners name
Recortfels ofice whare contrap
Record number � Pa9e
Counry 7ovnship Tatin Aistrict (ciry, tawn, tawnshiP)
Parcel number Legal descrip' n Is Ue pmperty in estion:
Q —Q��j '�' �� �eal property ❑ Mobile Homo Q.C. &1. f-n
If any portion o( the resideni7al sWGUre or the land nol exceeding ona (1 J aae that immediatey wrrounds that swcture is used W produce income, describe Me use and portion
ot the property ut7ized to produce income.
County
-/U �Jlo ^
F��.�Y;PROPERT:Y;'
Twvnship
I hereby certity the above statements are We, corted and complete.
Address (numbei arW street, dty, atafe, ZIP code)
=-IOD. .��5� O�/
County
of Gaimant
;.. :�. _ ��.,_... �,1..m �➢Sy' �,�.rS�W..K- ' _ I � "'pl`M ;� �-- ' ' �, . - . .._
�5'��.-t-�'.�:...�'�'- �, siTc�.s�,4�'•e go,„�,�-,�„ STANDARD:OE�UCTION,4LLOWAlICE�;'�..���`u�.q,�X".,:�..—`�-;.��s,i�'�•'�z.«.t"�.s3'.�.�-'�'`S'._„c��'Fr-�^.F
20 _ Pay 20 _
Lesser of 1l2 Homestead
$
v9uaLOn a f35.000
Si9naWra of Auddw " Date signed