HomeMy WebLinkAboutHomestead_Jines. ; CLAIM FOR HOMESTEAD PROPERTY iAX :; -.
CREDIT/STANDARD DEDUGTION ' � -
•�I�, Sl:tic F�xm 5173 (R614-03) ' . . •
Presvibed by ��e Department of Local Godemmem Finance ' ` ' �� �
INSTRUCTIONS: See reverse side 1nr liliny irti6ur.lious . �
� / FORM
. tn' r� HC10
�,,� 1
YEAR
".:_a �_.- •,., xiv;.a ���. , -ii';:�.':r ):;.GERiIF1GATl SiAlEMENTi 'e:' . ' rs.'.z: � ,
. . ....,:. " . . . > "._
��e) /`, � ,Y� certify tha(on the 1st day of March, 20
;I(W occupied as our principal place f residence the fo ving descnbed re mperty for which a Homestead Property T�c Credil is hereby Gaimed:
(We) owned ❑ Fve buying under contracl � � �"-1 T � � �
Have a beneficial interesl in ihe en[ity that is liable for the pmperty taxes on ihe property and thatg th�pr ert is y g u er a coniraU.
I( buying om m�trad, Fee Simplo ownefs name
Remrdels oifica where cont2cl is recordetl
GIBSON �OUNTY A
Page
County Tamship Tating tli '. t wn. tow shi
� n m Legal descdption Is ihe pmperty in que
�3 j� � O� ' eal property ❑ Mobile Homo Q.G 67.7-0)
If any portim a! Ne reiCeniial stvcture w tha Wnd not axceeding one (1) acre lAal immetliately surtounds tha� swcture is used lo produce income, describe Ne use and potlion
af ihe propeny u�lizeA to produce income.
COUNy
Tavnship
1 hereb .� ove statements are We, correcl and cnmpiete.
�:�a
�tlress (num6er mM stmet ciry, state, ZIP code)
�(D8'� adt �rikc.G.. TN S/�G}e
Land nol exceeding 1(one) acre immediately
surrounding residenlial improvemenls.
Other land
TUaI land (line 7 plus line 2)
Dwelling
Residential improvements or Mnuatly
Assessed Mobile / Manufactured Home Garage
Other improvemenfs
Tdal improvemenls (line 4 fhrough line 6)
Tdal value (line 3 phs line �
I hereby certi(y the above is We, coned, and
complete.
Veri(�ing acfion - $ig�ture of PuCilor
20 Pay 20 _
Lesser of 112 Nomestead
va�uauon or 535.000
SignaWro oflwditw
(�)
�2)
(3)
(4)
(5)
(6)
(�)
18)
Sgnature of Assessor
Counry
5
ot
Toxnship
Dale signed
Date signed
.Y;