Homestead_Long(�A�� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
�� � Siate Form Sa73 (R6 / 403)
Prescribed by ihe Depanment ol Loca1 Govemment Finznc�
INSTR�TIONS: See revcisc sidc /or lilinq fnslmcfinns.
I (We) �"�l
I(VJe) occu ied as our principal place of resi e th foll
��VJe) owned ❑ Are buying under con�ract
� Have a bene(dal interest in ihe entity that is liable for
c�rv�<+k5."x'?:':�f Y.- _'-.Sar .�-�":� .. �e"�„�
if buyinq on contrad, Fee Simple ownefs name
Remrdefs office where coniraa is remrCed
\M.� FORM YEAR
r � HC10 �
ie�cribed real property tor which a Home:
�rry taxes on ihe property and tha � r(5
CONTRACTRECORDED�,'"�'.'-'°' ��"F
GIBSON COUNT
Rec� ord number
Page
a.: °s-.. . .. . ,.-:.. .o..,r,.. ' i`ts"',"�, ._�.:...+. -... , .
�-�-� r.�r_.^•.. -.. . -. _. . • s. r•�;.. -;aPROPERTYDESCRIP.TIONe%,� - ::.��_.. - .a � .s�7>�; .....
Counry 7py��ip Tacing Uislrit� (tify, fown, own i
n r g escription Is ihe v�operty in estion:
` ❑ Real property ❑ Mobile Homo (/.C. 61. f-7)
if any portim ol the residentlal strucWre w the WnE not eaceeding one (7) acre Nat immediatety surtountls that swaure is useC to produce income, tlesaibe the use antl ponion
of tha property utilizeA to produce inwme.
s3c� - �. ��a -o
�: i e ^��-. : � ° '�s._<.�s� -.� - :.--.=` .:FROBERTY.OWNED:BY CCAIMANTiN�OTHER'COUNTIES - . .. � � ,x' � � _.:� �',-- ,"-' --"•'`.
Counly Tornship Couniy Toxnship
I hereby certi(y lhe above statements are W e, covect and complete. Signawre ot claimant
S� ��
dress (number an0 street, ciry, slate, ZlPCOtle) '
2.Q. 3 8ox ltl Owaasu��e � �1lbbS
r s�'=iiy ,�i,?a�`'r ° -� ' - - TRUE TAX ASSESSED VALUE : HOMESTEAD NON-RESIDENTIAC.�
�,, NA''7�:.�„ASSESSORUSEONLY . , ��� VAI.UE � AT100%OF.TTV- � VALUE �...�'VALUE�
nd not exceedinq 1(one) acre immediatety I -. -� '• -
s « ounding residential improvements. (� % . -� ' - � - �
Oiherland (z)
Tocal land (line 7 plus line 2) (3) I
Dwelling (4) s � ; y _ �- �
:w.<
Residenliel improvements orAnnually � ;Y ;
Assessed Mobila I ManNacNrad Home Garege (5) .
Other improvements (6)
Tclal improvements (line 4 through line 6) (7) I I
TUaI value (line 3 plw line n �g�
I hereby certi(y Ihe above is true, conect, and S�gnawre or ossessor oa�e siqnea
complele.
Vefitying aclion - SignaWre oflwtlitor Date signed
_ :,:..:,_ �
20 _ Pay 20 _
Lesser of v2 Homestead
y�u3uqn or 535.000
'= =�STANDARD.DEDUCTION
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