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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION '
State Fortn 5473 (R2 / SA2)
INSTRUCTIONS: See reverse side lor filina instructions
FORM
HC10
YEAR
- � E
1 CERTIFICATIO T TEMENT � ���
� �We) certify that on �^t st day of March, 19_
I(We) up d as our princip place of residence the following described real property for which a Homestead Property T S�diQsfi/er�9�aimed:
I(We) owned ❑ Are buying under conhact � � � /n[
❑ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prop is b'�u d�t' e contra t.
� GIBSON C �x,rAUDi�
u �rv
CONTRACTRECORDED
If buying on conVacL Fee Simple ownets name
Recortlers otfice where contracl is recorded . ' _ Record number Page
PROPERTV DESCRIPTI
Counry Township Taxing tli "(ciry, t , town " -
a mber Legal tlescription
� O � �
Ii any nion of Ne residential structure or the land not exceedinq one (7) acre that immediatey surtounds that swcture is used to produce income, descnbe Ne use and portion of
the pmperry uGlized to protluce income. �
PROPERTY OWNED BV CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Signature of cWimani
�reby certify the above statements are true, correct and complete.
Address (number and streeL ciry, state, ZIP aoUe)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately (� � -
surrounding resideniial improvements.
Oiherland (2)
Total land (line 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Other improvemenis (6) �
Total improvements (line 4 through line 6J (7)
Tota1 value (line 3 plus line 7J (8)
I hereby ceNty the above is true, corteCt, and Signawre oi Pssesor Date signed
complete.
Verify"u�g action - Signamre of Autliror Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _ -
Lesser of 1/2 Homestead $
Valuation or 52,000
SgnaNre of Auditor Date signed �