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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R2 / S92)
INSTRUCTIONS: See reverse side (or7iling instructions.
FORM
HC70
YEAR
CERTI TION STATEMENT
` I(We rtify t y o arch. 19_
I(We) pie as our 'ncipal place of residence the following described r al property for which a Homestead PropeFrtxT�c �re$iOp�ereby claimed:
(We) owned ❑ Are buying under contract - . -
Mrd( 1 � u
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❑ Have a beneficial interest in the entity that is liable for the property taues on the property and that owns th �roperty or i b under co ct.
CONTRACT RECORDED GIBSON "'
II buying on contran, Fee Simple ownels name
Fecortlers oflice xTere con[mct is recorded Record number Page
PROPERTY DESCRI � TI N
Counry Tovmship Tauing istri (ciry, rown, townshipJ � �
bero Legaldescription '
If any portion of Ne residen6al stnxNre or the IarW not exceetling one (1) acre ihat immediatety surtounds Ihat sVUCture is used to D��? ��rt�e, tlescribe Ne use and portion of
the property utilized to produce income.
�� -/9-/0 - /oo - � �. a33 - 0�.5"
PROPERTY OWNED BY CIAIMANT IN OTHER COUNTRIES .
Counry Township . Coun 7ownship
ig re ofclaima nt
��ereby certify the above statements are true, correct and complete. // � S
�Y
Ad e s(number antl street ciry, state. ZIP e)
�f� z �Gy � � 7,,r/ �GY�
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediatery (� � . �
surrounding residential improvements.
Otherland (2) I
Total land (line 1 plus line 2) (3) �
Dwelling (4) '
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 Ihrough line 6J (7)
Total value (line 3 plus line 7J (8)
I hereby certity the above is Irue, correct, and Signature of Assesor Date signed
complete.
Verilying action - Signamre oi Autliror Date signetl
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 7/2 Homestead $ �
Valuation o 92,000
Signature of Audiror
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