Homestead_McGathyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stste Farm 5173 (R6l I-03)
Presaibed bf'tM DeGeronmt ot Loeal Govemment Finaxe
INS7RUCTIONS: See ieroras aHs hr BYg iqbuc6'w�t
�
FORM YEAR
HC10
��e) � certify ihat`aB�th� 1 st�ypJ _March, 20_
p�r ���
I�(V^Je) occupied s our principal place of 'd nce the (ollowing descnbed real property for which a Homestead Property TaC�redit is tlereby daimed:
�i'(We) owned ❑ Are buying under contract GIBSON COUNTY AUDITOR
�
�ve a benefitial interes[ in �he entity that is liable (or fhe property taxes on the property and that owns the property or is buying under a wnVad.
I( buyirg on conUad, Fee Simple owners name
Recotdefs ofite whera mnVaq is recorded
County
Tamship
Taing district (dry, ro�n, fownshiP)
Record number � Page
Parcel numt�6e'^r �I r I Legal description I�1he properry in �sUon:
O Q J �(;,�, �p �� -�� �\ �ieal pr pgrty ❑ Mobile Homo (/ C 61 1-�
I�fr �y� poM1ion a/ the resitlanUal sW cture ar Ne land not wcceetlinp one (1) aae ihat immetliatety wrrounds Ihat swcture is used tn praduce incoma, desvi6e 1he use and portion
ProPa+tY uti¢ed to produce income.
� of�v • /�-a3� '`�CIJ - GY��7 .` �00 -1�- Qo?/ �
������'�°'"�+���';"R��n'���'� � � . �TRUE N(�� ASSESSED�VALUE �,HOMESTEAD�'»'� ' NON-RESIDENTIAL �h
�'A&4ESSOR�USE ONLY����j���+y� �S.VALUE���� "/1T 100Ya OfITV '�.VALUES � �,�� �� �.--�.,��;� �
�: w5ar�,i�.t��'�'"r3��' �i�'t^.:. �:+�_.-._.-.� 3.-.PS....�.�+vi.�c,,.,.�...rX� f��VALUE.C„T....T �.,
Land nol exceeding 1(one) acre immediately r�'�,,�,?,t�+�t`"''�'*y`�'N��e�mK-,'��C,g
suvounding residential improvements. (� � • i �g"d�°�.ra�'"_ ° �:' � ��_}<
Z {��-�+ y��.:e� .
Other land ( � r�? ' �
, __, x��=��
TUaI land (line 1 plus Irne 2) �3�
Dwellin9 (4) a�� �r ..,�,��t����r�'nf
�Residentiel improvementa orMnuaDy �'�'�"� ;z "x'`' -'�`�'��'r'�
As� MobOe / ManufacNred Home Ga2ge (5) ,��+���'�;���,� .;`:'°a,�,°���3
�i.`'�'��uvi�:�ss:r._ �..l�::i'
�'�s`�-` �)
Other improvements (6) �� �+=' f a
, s.x� r+.�"�.s-Q,
au34..ar.`,r
To1al improvements (line 4lhrough line 6) �7�
Tdal value (line 3 pl's line n (g�
I hereby certify �he above is We, corred, and Signature of Assessor Date signetl
complele.
Vai(ying aUion - SignaWre of Auditor Date sgnetl