Homestead_Williams (15)CLAIM FOR HOMESTEAD PROPERTY TAX FORM J YEAR
CREDIT /STANDARD DEDUCTION HC10
State Forth 5473 (RS / 4-03)
Prescribed by the Department of Loral Government Finance f ,
INSTRUC77ONS: See revsrea a des b MV irmurXionc .
I (We) , j2n-rn ,ter n� 1 � ��C� I (Z [Z a certify that on the 1st dayyj�jlarch, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property �f 1' s erg daimed:
r� (We) owned ❑ Are buying under contract 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.
sdr- "s7t- ��`CONTRACT.;F2EC0_R_DED`: -.; x' zP': �''# F� '�`�'�'K;:��'a�',��.�"�'i.,:.e •�- ,:;'s'�`f.
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
�,_:.'-i=3, -.��,• � �' `"'-- �' +1��.�,�.�,PROP.ERTY ;OWNEDrBY CI' AIMANT ,INrOTHERCOUNTIES�`��.' -�5 .?�� �- .z�_u'#�1,YS•""•'
County Township
-R . Y,' 1 I - to r c
P, ROP,ERTYsDESCRIPTION= �a�"`�' -`.
County
Township
Address (number and street, city, state, ZIP code)
Testing district (rily, town, township)
Parcel number
egal description
Is the property in question:
al property ❑ Mobile Homo
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stallcture is used to Produce income, describe the use and portion
of the property utilized to produce income.
�,_:.'-i=3, -.��,• � �' `"'-- �' +1��.�,�.�,PROP.ERTY ;OWNEDrBY CI' AIMANT ,INrOTHERCOUNTIES�`��.' -�5 .?�� �- .z�_u'#�1,YS•""•'
County Township
County Township
1 hereby certify the above statements are true, correct and complete.
Signature cl " ant
Address (number and street, city, state, ZIP code)
`:.'1- ASSESSORUSE ONLY=g
TRUErt
�VALUE`'+r'EATk100
ASSESSED VALUE
HOMESTEAD
rt?
'`'x NON ttESIDENTUIL
gm
%.OFT.fY
VALUE.?�'..�,
..r^'n''aa.'.- .
e. _bALUE'a+af. .
Land not exceeding 1 (one) acre immediately
+' $ ," ".,e• -:>wi
surrounding residential improvements.
Other land
r
-rtes
A we
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
iy „V „-�• gA
}-{ ,+�, 1t,.?5
(Residential improvements or Annually
.ua drt,Ly ts'
Assessed Mobile / Manufactured Home
Garage
g
(6)
Other improvements
(6)sL.
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
"'Gr } 'P -'-k-, �' 'STANDARDAEDUCTIONALLOWANCEf* ^�: .M,
.fD�`y,�.",.3"tr ._ '. a% �. �'. r#+ �C. a�fi?.
20 _ Pay 20 _
Lesser of 12 Homestead
vauatrrxt or f35.000
Signature of Auditor
Dale signed