Homestead_Sanders�� v.p R
.a , t CLAIM FOR HOMESTEAD PROPERTY TAX R
r,�� CREDIT/STANDARD DEDUCTION C
B Y Y r., State Form 5473 (R2 / 5-92)
'�� APR 0 8 1999
.,.
INSTRUCTIONS: See �everse side lor liling insfructions.
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. :.- . . •-".. ..- ' . � - � -`:-CEHIIFICA STATEMENT: � � �t: ;' �'; . �`� -"� .. :11�i - .
GIBSON �
�(We) _ certity that on the 1 st day of �March, 79_
Ve) occupied as our princip I place of residence the following described real property for which a Homestead Property Tax Credit is hereby daimed:
1(We) owned ❑ Are buyinq under contract
Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns ihe property or is buying under a contraa.
. - . CONTRACT RECORDED_ � �r. �'�-= . . - -'-�'� '
tl Euyvg on conhad. Fee Simple owner'S name
Recortler's office,w�ere Contract is reCOrtled Record number Page
� ' - ' PROPEHTY DESCRIPTiON � � � '� - � � �-" - �
Caunty TownShip T3xirg distriq (Cily, town, fown5hip)
number �Legal descrip[ion
�l .. P� � Q'7 Q- 1\
If any portion of Ihe resbential strudure or the land not e•ceeding one (t) aae Ihat immediately surwunds [hai 5trucNre is uSCW to produce income, descnbe lhe use and portion
of the properry utilizetl to protluce income.
_ /9_i9- �� - �a/. %��- O�s
. �- ��� ASSESSOR USE ONLV " TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIA[; �
� � � � VALUE VALUE VALUE . �- VALUE �
Land noi ezceeding 1(one) acre immediately � �� �
surrounding resideniial improvemenis. (� � � � R`. �
; _
2
Oiherland �p) c�o. .�
n d. . .
Total land (line 1 plus line Z� (3)
Dwelling (4) . " - �� '.
y.
Residential improvements _ , .
Garage (5) ° `
Other improvements (6) - �
Total improvements (line 4 through line b) (7)
Total value (line 3 p�s line � (g)
I hereby Certify �he above is true, correCi, and SignaNre ol Assessor Date siqnetl
wmplete.
tyug aaion - Sgnawre of Audiror Date sgned
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SgnaWre of Auditor
19_Pay19_
Lesser ot 1/2 Homestead
Valuation or $2,000 $
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