Homestead_Klusmeiert�E 5^��F 4
� `,
;i �
`'�e�.
CLAIM FOR HOMESTEAD PROPERTY-TAX
CREDIT/STANDARD DEDUCTION
State Foim 5473 (R2 / S92)
INSTRUCTIONS: See reverse side /or filing instructions.
FORM
HC10
YEAR
Q� _
� C IF ATION STATEMENT _
I(We) certify th�t�15 ay ofllaIDh�
,
I�(W�e) occupied as our principal piace of residence the following described real property for which a Homestead Prop T re it i b l e
�I (We) owned ❑ Are buying under contract � � ' g ���❑
❑ Have a beneficial interest in the entiry that is liab�e for�the property taxes on the property and that owns the property or i�g�rtded2tStldtract.
�
CONTRACTRECORDED
If buying on cantract, Fee Simple ovmers name GIBSON COUNTY AUDITOR
Recordets office where contract is recorded Recortl number � Page
� PROPERTY DESCRIPTION
Counry Townshi0 Ta<ing district ( iry town, township)
ar�n�berO�o� _�'\ Legaltlescriptlon
V
It any portion of the residential structure w the land not exceeding one (7) acre tliat immediatety sunounds ihat swRUre is used to produce income, descnbe the use and poNOn of
ihe property utilized to proGuce income.
0��-/9-0�- aa - oa�. a�9- a�s
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Caunry T Counry 7
Signature of claimant
�iereby certiry the above statements are true, correct and complete.
Address (number antl street ciry, s7ate. ZIP cotle) �
�- -tQ. . � 3 0 � ' �! ?� � 9
ASSESSOR USE ONLY TRUETAJC /ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land.not ezceeding 7(one) acre immediately ��)
surrounding residential improvements.
Otherland (2)
Total land (line 7 plus line 2) (3) _
Dwelling (4)
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 fhrough line 6) (7)
Total value (line 3 plus line 7) (8) I
I hereby certi(y the above is true, conect, and Signature ot assesor � Date signed
complete.
Verilying acfion - Signature of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead � � -
Valuation or 52,000
Signature of AuAitor Date sig
- 3-