Homestead_RottetCLAIM FOR HOMESTEAD PROPERTY .TAX - FORM YEAR
CREDIT /STANDARD DEDUCTION '** . '."
Stale Forin 5173 IRS 14-031 ".n
Prescribed by the Department of Local Government Finam- - -
INSTRUCTIONS: See reverse side for lifing
(We) G certify that it , qWarch, 20
I (W which a Homestead Prop,
1st
e) occupied as our principal place of residence following described real property for A5 71t �1� Llreby claimed:
I (We) owned ❑ Are buying under w ct GIBSON COUNTY AUDITOR
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
coNTRACTAECORDED_,k�',
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Rewrd number Page
5 PROPERTY. DESCRIPTI
9n
County Tmnship Taring dish' ( lye.. t9imm wnship)
('0 A 6,: V V/ e 'd-)
Parcel n mbe L/$hl d&cnption Is the pro piny inRuestion
_ZU6� � � leat property bile Home (LC. 1. 1-7)
ure or Me land not exceeding one (1) acre that iffintscitl surrounds that qt,6�b lie to Produce income, describe the use and portion
ugUCa income.
if kwbwntd�dy CLsk I uAht IN OTHER -COUNT I ES
County
Township
County Tmnship
I hereby certify the above statements are true, correct an . d complete.
ign re I claim n
VALUE��,
ress bar and street city, state, ZIP code)
_e
0 c-5 A 0- \< '& 12 sT 9 '7 C
...... — P<'
SSESSOWUSE ONLX�6-�,.44,;�.
A
"S ESSEDMALUE
HOMESTEAD�
j -RESIDENTIAL
?,NbN
VALUE��,
Lesser of 112 Homestead
_e
YA'Lq
S
.4
Land not exceeding I (one) acre immediately
Signature of Auditor
surrounding residential improvements.
Date signed
Other land
(2)
4
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
"v
AF Ikx
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
W.
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
-'STANDARD.DEDUCTIONALLOWANCE
20 _ Pay 20
Lesser of 112 Homestead
S
Valuation or 535.000
Signature of Auditor
Date signed