Homestead_Young (12),� ; CLAIM FOR HOMESTEAD PROPERTY :TAX �. � . . ., �fr \� FORM YEAR
CREDIT/STANDARD DEDUCT�ON � I� � HC10
\t y� StaieFU(mja73(R6/403) . . '
�, _ . �
I�'{� WmscribeG Gy t�e Deoartment o� Local Gove�nmeni Financ.� ' ' �
WSTRUCTIONS: See revase sidc lor liliny insbur.li�i�ii. '� • � ' ' • �
��r.ts=.=-" -
��e) � �� � � � certi(y that on t 1 st day of March, 20_
I(W�upied as our principal pla f residence the following escnbed real p erty for which a tead Property 't � daimed:
I(V✓e) owned ❑ Ne buying under con�ract � ' GIBSON COUNTY qUD170R
, Have a benefidal interest in the entity Ihat is liable for the property taxes on Ihe properry and that owns the property or is buying under a contraci.
t"�^s.'=,�""�c°,yi..�:.s:`�-3' �=3:�;=�. ac;��.--•`1 -�CONTRACPRECORDED%';: ' -`c1' . - .
If buying on contaq, Fee Simplo ownefs name
Remrdefs ofice whera convact is recorded Record number Page
•- _ -, . i :=.�: ' . . . ..
County Toxnship � Tsing tlist' ('ty, f wn, t ship) �' �
I
I n� er (�(� Legal descripiion Is t�e property in question: .
�_� l S 4� W �al pmperty ❑ Mabilo Homo (I.Q bf. t-7)
I( any portion al Lhe rasi0ential strucWre w No Wnd not exceeEing one (1) aae that immeAiately wnounds that sWCture is used to produce income, tlescribe the use and portion
o! Lhe property uBuzed to produce income.
County
Twrnship
County
I hereby ceNty lhe above stalements are true, conecl and complete. �9^a ol
-d�ss fnom6efarrd sfreef, ury, stafe, ZlPcode) �
Land not exceeding 1(one) acre immediately
sunounding resiUential improvements.
Olher land
TUaI land (line t plus line 2)
Owelling
Residentlal improvements or Annually
Assessed Mobile! Manufactured Home Garage
Other improvements
Tual improvements (lina 4 through line 6)
Tdal value (line 3 phs line n
I hereby ceAify the above is We, correG, and
complele.
Vrriryirg acl'pn - Signature oflwditor
20 _ Pay 20 _
Le;;er ot 1/2 Homestead
VruaLOn Of $35.000
I�1
lz)
(3)
(4)
(5)
(6)
(�)
(8)
Sgnature of Assessor
2�
Date signed
Date sgned
' � \ Q , � � "-I Date
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