Homestead_Lynn��:
;t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Fwm 5473 (R6 / 403)
Prescribed by the Departmeni W Local Govemment Finance
INSTRUCTIONS: See reverse side lor lilinq insfrucfinns.
FORM YEAR
HC10
�4i '' t� 1 2�.�'
I(We) / Vi certify lhat on the tst day of March, 20
I(We) occupied as our principal place af residence the foll m describe al property (or which a Ha�estead Propeity_TJai Credit is hereby daimed:
�I (We) owned ❑ Are buying under contract ��^�"`��J7`�""�-�✓ �
/� GIBSON COU4T'r Au�iTQF
, Have a beneficial interest in the entity ihat is liable for property taxes on Ihe property and that owns the property or is buying under a contraU.
If buying on conVaq, Fee Simple ownefs name
Recordefs olfica whera contraq is recor0ed
County
L_fi/ / '
N any poAion of
or the property u
Record number � Page
Toxnship Taing dis 'c 'ry, tqwn, fownship)
Legal deuriDUon Is the property i question:
Real property ❑ Mobila Homo (LC. 6f.7-7)
sWCture w Ne land not e:ceeding one (1) aae Ihat immediatcy wnounds that s cWre is used b produca income, describe Na use and portion
ice i�ome.
-/e�-afL/°/-��o. a��-a��-
County Toxnship County
I hereby certify the above statements are W e, coned and complele. Signawre ot daimant
�
`Ad(dress (num6erandSUeet, city, sfafe. ZlPcade)
`PQ\'D._'iull�_�/ �:.li�n.�,,.�.A / U"li_i�Q
20_Pay20_
Lesserof 1/2 Homestead
vaWaUOn a 535.000
S
Sgnature of AuOitor " � Date signea