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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Siate Fortn 5473 (F2 / S92)
INSTRUCTIONS: See reverse side foi (iling instruc6ons.
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FORM ''�,
HC70
YEAR
RTIFIC ON S AT ENT
.(We) certify that on 1st day of March, 19_
'I (VJe) occupied as our cipal place of residence ihe following described real property t which a Homesiead Property Ta�c Credit is hereby claimed:
❑ I(VJe) owned ❑ Are btrying under coniract 1"'1 ����
❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns the ����'.�rty r i uymg er n ct.
1
CONTRACTRECORDED
It buying on contrad. Fee Simple ownefs name
Recordels oHice where conVact is recortletl R r P e
- GI SON COUNTY AUDITOR '
PROPERTY DESCRIPTION �
Counry Township Tasing distri (ci fown, fown ")
Parcp�numb�� Legaitlescnption • � � �/
! 1 11 /
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It any poNon ot Ue residenlial structure or the land not exceeding one (7 ) acre that immetliatety rrountls thal sUUCture is used to produce income, tlescribe the use arW portion of
the ProPenY util¢�xy��er J \
OC ✓ l.`J, � /
�G -/ 9-�� �`aa - oao. � 9� = a��
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
' n ur claimam
�reby certify Ihe above statemenis are true, correct and complete.
..tltlre �number arM sLeet, ci �a(e, ZIP code) ^ _ 1,
—II
9�— C � t� �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately �� �
surrounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (a) .
Residential improvements
Garage (5) .
O[her improvements (6) � .
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7J (8)
I hereby CeAify the above is true, correCt, and Signature of hssesor Date signed
complete.
Verityinq actlon - Signature of Autlitor Date signed I
STANDARD DEDUCTION ALLOWANCE
79_ Pay 19 _ .
Lesser of 1/2 Homestead S
V uation or 52,000
Si tu f AuAitor Date sig,
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