Homestead_RemerCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� smca r� saa �� i sas�
Prescr3�ed by ihe Deperinient of Laol Govenment F"uwwe
INSTRUCTIONS: See ieverse side (a filing instructions.
FORM � �R
HC10 �
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i M'e> �/� � l P r (i °'f �!., �la J � P,-,, r r-- certify that an fhe 1 st day of Mard�L20 /
I�ocapied as aa prmdpal place of residence ihe folbwirg despibed real property for whirh a Homestead Property T�c Cr�.�m��med:
I(We) owrred ❑ Pre buying urMer contract G�BSON COUNTY q�D170R
�Have a benefiaal mterest m the entity that is IiaWe for C�e {xopeAy lazes an the property and that ams the property w is buying under a contract
rc dryore a, mnUaG. r-ee sirr�le aMnera rmme
rtec«ders wbce w�e cumaa is remrdea
��o:]SVHi{'^ .a��!����'�°%-�i.i;�;Gtl1i�rt`fe!- vyPKi �
Casb 7amsldp
Record number � Page
Parcel ramber Legal desc+iGlion Is tha property in question: /
"�T' � NE �S ��i ii�FeD��.b ❑�� ❑ MohileHome(LC.6/.7-7)
H arry pation of iha residarEial struGUre a tM la�d no1 maeading one (1) acre Nat'unmeQaldy surtounds Uat #rucMe is uaeA m praduca "vimrtie. descnbe fhe we and Pa�n
d Ne property uli6md tn W�a mmme.
a�,-IG-�s-�oo -aoo,a9i-o�.(
Counry
� t�ereny cerery me abwe sra�rt�ents are we� mr.ea and cortplete.
(nuMer end �aet dA: siate. ZIP oode)
Lend not ezceeding 7(one) aae i�ately
surtoundirg residential improvernents.
O�herlarM
TUeI land (fvie 1 plus Nre �
Resdential improvements w Mnually
0.ssesseA Modle / Manufac4aed Harne
Otherimprovernen5
o �o Pas�
t ,�..� ���i ,��TRUEiTAX?+��'.�'r"i
't: �:rS.x.,: ..._ri:VALUE�:�i'`::i
,t��.�.,;r.a�- _.x_
(�)
(21
(3)
Dwelfi^9 �4)
Garage �5�
(6)
TUaI'vnprovert�ents (6re 4 7hrougA 6ne 6�
�
Tolal value (lirre 3 pda Gne n
I liereby certify the abwe is true. cared, and
eampleee. '
�tl�;rq amon - sipnaaue otn�wmr
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(8)
sg� m��
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Date sgned