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CLAIM FOR HOMESTEAD PROPERTY TAX
4: Tilt CREDIT/STANDARD DEDUCTION HC10
State Form 5473(R5/10-01) 1
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Prescribed by the Department of Local Government Finance . FORM YEAR
II
' GIBSON COI.W'r t AUDITOR
P r•--LHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
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It41-nititia;lit.--:44t,Msaglizir:37M4S1WI-,-;CONTRACT REcoRDEo
If buying on contract.Fee Simple owner's name
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Recorders office where contract is recorded _ Record number Page
1.4-VW.;g1C-Vini4:".:41tYM-Vicfn-r-f.Shit3-r-^1151 -475.:'P,R 0 P E RV(.D E S C RI PT I 0 N"r'24'7_t:;41:11.1t-WItrni".Wr-:/?1.1-qt'-';'..:1:4.;;;.S
County Township Ting district(city,town,township)
P -I• • ber 1)- Legal description w Is the property in question:
0 Real proper)/ ITA4e Homo Q.C.6-1.1-7)
If any portion of the residential structure or the lard n tUding one(1)acre that immediatfl surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
7.-C--ra-5-3-.4-TaleN-Wee774gett--,74-t:Le-51.12ROPERTIOWNED BY CLAIMANT1WOTHER'COLINTIESie:ZWAW:ank-?;:--t.t.14W'r County Township Township County Township
nature of claimant
I hereby certify the above statements are true,correct and complete. Sig i
"C'Stat Z(Aar—
FArcl‘dresIzrnizastrt5,...city,..ttcoaib if jemn .4.1 ,.i cp
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ParCliiirfa‘'.'91tral-1€4..,SWiat-1 it;+Wigs Cul'iiiiiiiiiitiE „..,416iiiiiii,,,.1;: rrtPt.„,"liiiirriiiii5finiai.,,R§L'm
efttai- WEssjAk-T! ST11:YP.,- 0-4{-&fili..-.44vALPE2Ntg: IAT!..iorgorrryt a-;;IVALEst k.,-'1411,..MPVALUE-U..)11:1‘4":141‘:}3
Land not exceeding 1 (one)acre immediately W.ifya'at:e.it.714.7itt;t,',.,;((i
surrounding residential improvements. (1) -.2LV-486,14-jc.itt";'",.'"a
Ze:c.,1-1.-Ne:477'416547:-t-T1C "
Other land (2)
..1,,,c3:;intlin1+.35slear,
Total land(line 1 plus line 2) (3)
Dwelling (4) 74:Vsk'latisF:iW,2,4-h*.49.z,19:--y-
Residential improvements O'S...tifirkt-atnter445--1.4:-. ..&%-..4nilict,
Garage (5) jciT.2-74,434WW2.7S:NZ;I:::
4- :•4-lr.:1-.54--ittkria';4t-,-14::1-c.:".'
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
--tbatISE--WaYglaineelt■eta tglactiff STAN D RD:DE D U C TI 0 N AL L OWAN C E 4,',2tItzrgi,a3M;;;Zeitd,"*,07".71V410,,,11,-C,
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r>411\ 20 Pay 20
Lesser of 1/2 om
Hestead .
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U. Valuation or$6,000 (1)/ S{qc N K\ \
Signature of Auditor tsull Lt) Dattsigneicla
R- a-0t?l
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