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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fortn 5473 (R2 / S92)
INSTRUCTIONS: See reverse side lor filing instructions.
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� CERTIFICATION STATEMENT
I(We F^'� �`-� ce� t n the d of March, 19_
I(We) occ pied as our principal place of residence ihe�following described real property for whic it hereby claimed:
❑ I(We) owned ❑ Are buying under contract GIBSON COU A�
❑ Have a beneficial interest in the entiry [hat is liable for the pmperty ta�ces on the property and Nai owns the property or is buying under a contract.
� CONTRACTRECORDED
II buying on rnntraq, Fee Simple owners name
Recoiders office where contract is recortletl Record number . Pa9e
PROPERTY DESCRIPTION
Counry Township Tazing disirict (dry, town, township)
P�ce umbe� � Leg d ption _ � ' / � �
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If any poNOn ot the residential stnx[ure w Ne land noi exceeding one (t) acre that immediatey sunounds that sWCture is used to produce income, tlescnbe the use antl poNon of
Ne properry utilized ro produce income. 1
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PROPERTY OWNEO BY CLAIMANT IN OTHER COUNTRIES
Counry Township Counry Township
Signat oi daiy�ent i
�nereby certify the above statements are true, correct and complete. �/! _
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Atltlress (number and stree{ ciry, sfafe, ZIP code)
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 7(one) acre immediatety �� �
sunounding residential improvements.
Otherland (2)
Total land (line 1 plus line 2) � (3)
Dwelling (4) '
Residential improvements
Garage (5)
Other improvements (6)
Total improvements (line 4 th�ough line 6) (7)
Total value (line 3 plus line 7J (8)
1 hereby certiry the above is true, conect, and Sgnamre ot assesor Date signed
complete.
Verifying ac6on - Signature of Auditor Date signed
STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 1/2 Homestead r�
Valuation or 52,000 �
SignaNre ot Auditor Date signe0