Homestead_Glover (2)n
' CLAIM FOR HOMESTEAD P.ROPERTY TAX
�' CREDIT/STANDARD DEDUCTION
\ Siate Fwm Sa73 (R6l d-03)
' Prescribed by the Departrnent o1 Local Govemmenf Finance
� INSTRUCTIONS: See reverse side for filing insfi�ctions.
,,
� FORM YEAR
� HC10
�
� M'e) � � �b`" � rtify that on tha tst /d1a'�y r" Ma�cn, zo
I(VJe) occupied es our prin I place of residence the following describ al erty for which a Homestead Prop��Crea�e�pereby daimed:
V
,n I(We) owned ❑!ve buying under contrect GIBSON COUNTY AUDI70R
Have e benafidal interest in the entiry that is liable tor the property taxes on the property and ihat owns the property or is buying under a conVaa.
I( buyinp on cpnVad, Fea Simple owners nama
RacorOefs oflke where convsct Is recorded
Counry
rovnsnip
tawrr.
Rewrd number Page
P�/ °o�-o�ya�-m IL� I P� �.�j,(/ /(�e� � Rea p perty ❑ MobOeHOme(l,('/57.7-n
If any poNon of ihe residential structure w Ne IvM not exceeding one (7 ) aae that immediately y��9Qs Nat Wcturo Is used to produce incoma, dascribe Ne use and portion
ot the property utllized W produce incwna. / (;
/X(e - / /'/ %- u SOU � UU 7. %!/'
Y^-'r'x c�<".v ' yy"1 _. _. _ _ _ _ _ _ _
�a:�z w�sa,z.'�� �.�� i.•_ .�Er�..:"�.P,RO?ERTY.OWNED�BY
County To.v�ship
I hereby certify Ne above stetemenk are We, cortect and complete.
tress (number and sUaet ciry, stare, ZIP code) �/ �
n� n ,�,.n .. _
'��` ' ����'������x��`` ���u�"'�� �^'�UE TAX �'� ASSESSED VACUE HOMESTEAD ` t NON RESIDENTIAL � � �
� ;.,�+'`�4SSE �OR US�E ONL^�-_Y ,, . � , a } .. „' �. V/iLUEx�`� . �AT,100% OF TTV c- � -q �
'�- r�`i.K t xt � s '�VALUE `�-°c 5.3 -. mEV/1�UE3� ��..�:..
Land not exceeding 1 (one) acre immediatety :.' S ,'-� -� _� -` ���;y;.� � - .-
surrounding residenUa� Improvemen45. �� � ° . �;;; i r - �r � � ., �.
Other land �p� - :.�;'• °� ��
?z : -
Tatal land (Ilne 1 plus llne 2) �3�
.w -- � , g `?F � 4� - �..
Residential improvements or Mnuapy ��Iing (4) .�"'t ��j� T �,��; � �.Y?�..5�;�
Pssessed Mobile / ManufacNred Hwne "; _-" � K'�= � � .� �-� "
Garage �5� . , .�-;, � ,� : i r� ''��,�
:a ': +. � _ �s �
� ; � .
O�perimpmvements (6) �`: ,s �:...
,a .
Tdal improvements (line 4 through lirre 6) �7) .
Tctal value (line 3 plrs line � �g�
I hereby certify the above is We, cortecC and � Signaare ofnssessor � Data signed
complete.� -
Verilyv�p ecUon - Signature oflwdit« Date signed
20_Pay20_
Lesser of 12 Homestead
Valuation w 535.000
SignaWre
5