Homestead_Woolston�rt�n CLAIM FOR HOMESTEAD PROPERTY TAX
'�'"�" � CREDIT/STANDARD DEDUCTION
'e��� State Fwm Sa73 (RS / 70-01)
���� Prescribed by lhe Department of Local Govemment Finance
INSTRUCTIONS: See reverse side !or /iling inslructions.
_ , . . .- CERTIFICATION STAlEMENT
-�
FORM YEAR _i
HC10
�'����
��e) _(� certify ttrat on the 1st da�f March. 20
I(VJe) oaupie s our principal place of residence the following described real property (or which a Homestea roperty • � i� hereb� ai d:
�
� I(We) ow d ❑!ve buying under wn�ract GIBSON COU4i Y AUDITOR
�Have a beneficial interest in lhe entity that is liable for the property tazes on the property and ihat owns the property or is buying under a wntract.
.c�"-,�_,�>.'� s�s.�i.?�;Y .. s- . '.�.:,, : tv_:_ ::;;b;.i� ';CONTRACT'RECORDED:r;` r'-'.; .- �,,,�� : s � - '
If buying on conirau, Fee Simple owners name
Recordefs olfice where contrad is recorde0 Remrd number Page
Caunty
V--L—k—
If any poM1ion c
ot the properry
Toxnship
itlenUal sWdure w the Iand not exceeding one (1) ame Ihat
m produce inwme.
ESCRIPTION�: `.'.. .�`,-'-��'--: �`:
Tacing dislrict (ciry, town, township)
I IS t�e pmpetly in queslion:
❑ Real property ❑ hbbile Homo (I.C. bf.1-7)
surrounds Ihal sWGUre is uutl b produce incame, describe ihe use and portion
��� '� 5 ES OR SE ONLY S�-�� ��-- � TRUE�TAX t ASSESSED VAI.UE HOMESTEAD' " i } "�t -��•
�- �� �} . .� p . �t NON;RESIDENTIAL�.��r �;
,� .v;_.. ..� _ a �.i i:} . i:.. ' r? � � VALUE: . . . _AT 100%OF�.TN � VALUESb.r ,,. . , �.;,_ VALUE G eYy_•.
Vv
Land not exceeding 1(one) acre immedialely f+ �� �' �`-� �� k y°:. �
sunoundingresidenGalimprovements (�) ' k,..�^.�s,`� �,.=?.*z��' �•x'
�� � ., -
Other land (2) �� �+.. �-iF
_i
Tdal land (line 1 plus line 2) (3�
-1 3 s,�? C'/ 5`� -eiz�'� ' .
Dwelling (4) ' , "J r� ,c a�z... ��+v�.�-'.0
Residential improvemenis �Fr
�� x .
Garage (5) Z4,!i-�`� ���`is�„�d'y�,:
�°� � ,.:?'�... .��'.,.n,...
Otherimprovements (6) {'ni �;�
;� S. - �.r�_,,,.,..
Total improvements (line 4 through line 6) (7)
Tdal value (line 3 plus line n (g�
I hereby certify Ihe abOVe is W e, CAReG, and SignaNre of.�sseswr Date signetl
complete.
Vuifying action - Signature of Fwaimr Date sgned
20_Pay20_
Lesser of 1l2 Homesread
Valuation or 56,000
5
SgnatureofAu'G .. __/ 1 � I e•. I1V Y IVe1// lo' /ll ��O