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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fonn 5473 (R2 / S92)
INS7RUCTIONS: See reverse side,/orliling instructions.
FORM YEAR
HC10
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� - CERTIFICATION STATEMEN
I(We) �fu ity th the 1 ay rch 9_
I(We) occ ied a r principal place of residence the fol al property or which a Homes d Prop x C it i imed�
❑ e) owned ❑ Are buying under contrad � �� GIBSON COUNTY AUDITOR
❑ Have a beneficial interest in the entity that is liable for the property taues on the property and ihat owns the property or is buying under a coniract.
CONTRACT RECORUED
If buying on conVact, Fee Simple ownefs name
Recortlels oKce where coniract is recortled Recortl number Page
PROPERTY DESCRIPTION '
Counry Tovmship Tawng tlis �ct �(a�ty,�to�wn�, ro/wnshr�p)
L��'�i �-C-CI�' L/
Parcel number Legal de � �on
U —O/87 - f N� S� � � J ” �� �
If any poNOn of the residenlial swcNre or Ne lantl not ezceeding one (1) acre that immediately surtounds ihat swc[ure is used to produce income, deuribe Ihe uu and portion o(
the property utilized ro produce incame.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
n ture laima •
ereby certify the above statements are true, correct and complete.
Atltlre number and street, iry, state. ZIP catle) '
ASSESSOR USE ONLY TRUETAX , ASSESSED HOMESTEAD NON•RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(oneJ acre immediately �� �
surrounding residential improvements.
Otherland (2) �
Total land (fine 7 plus line 2) (3)
Dwelling (4)
Residential improvements
Garage (5)
Oiher improvements (6) -
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify Ihe above is true, correct, and Signature of Assesor Date signed
complete.
Verifying acuon - Si9nature of Auditor Date signed
� STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _
Lesser o( 1/2 Homestead S
Valuation or 52,000
S naWr o�AUditor , Dat signed
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