HomeMy WebLinkAboutHomestead_LasleyCLAIM FOR HOMESTEAO PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sfata Fortn Sr73 (R6 / 4-03)
PinscriEeC by Ne Department of Lxal Govemment Finance
INSTRUCTIONS: See reverse side Iprfiling inshucfions.
FORM 1,�
HC10
� � � �
��e) certi(y Ihal on the 15t day of March. 20_
I(N(e) occupied as our principal piace of residence foliowing described real propeAy for which a Homestead Property T�Rar il istih"e� 5y daimed:
� f pi
���A I(VJe) owned ❑ P,re buying under con ct GIBSON COUNTY A DITOR
; Have a benefidal inferest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a wntraG.
I( buyinq on contract, Fee Simple owners name
Remrdefs oifice where coniraq is remrdetl
� �"��..z�'„':«{.5-.�.v.y%?.-�,y,ece`. �=e.ni � ,,ar�flGB:y.i.T�
Counry n Tamship
Parcel
_L// / • E//ol T /'(/�/ I
N any ponion ot the residential sW c4ire w the
of the praperry uWized b produce i�xome.
Cescription
not exceeding one (1) ame
Tating
Is ihe
Rewrd number
fownship)
Real proparty ❑ MoWla Hwno
Page
wnounds that IGucture is used b D�� ���e, deuribe the use and portion
� r�'�;'N���'� �"" -`r �� ''��'t'�� �.,.TRUETAX� R ASSESSED�VALUE �HOMESTEAD�'�'F�NON;RESIDENTIAL�
'c��s`s ,`"tA55E350RUSEONLY`` �� +�t�' z '�� �� .� ��-���`.�v...,.Y w
�-f.'�.':��i..r"Y's. �y9.�'.>:a? ..,`� �.�k�a�""�,�'`..S` r���.VALUE.i, ez,v'_: „l1T�100°/a'OFTN� � VALUE� r �"S3 'VALUE�"x`'
Land not exceeding 7(one) aae immedialety U i�-'� � w'
surroundin residen6al im rovements. ,'� t'
9 P (�) 'w`r,'3o-� �ji[rv ���-.j.jr'
Other land �2� `� g��� z� �� `
�
r�o-`�"'. ��
Tdal land (Ilne 7 plus line 2) �3�
s :��y � ry�r 3�r�Y:��,�,c�. SF.ajz�
Dwelling (4) '"' �if�' �,`
�Residential improvemenLS orMnualty � ��^'F��"'���
Assessed Moblie / ManufaQUred Home Gara e �'e�` '��'t�`` ��
9 �5� ' *������"` - �"Y.tm�
�:�-.
���i�i'.. -c�;<,
Other improvements (6) ���>^ -'
'..z�:`�'���?-�.
4Y r� iL�.
Tdal improvements (line 4 fhrough line 6) (�)
Tdal value (line 3 plus line n (g)
I hereby certi(y UI0 above is We, corteU, and SignaWre ofASSeswr Date signed
complete.
Verilying action - SignaWre o(lwditor Date sgned
20 _ Pay 20 _
Lesser of 1/2 Homestead
vawanon w S35.OW
Sgnature ot Auddm