HomeMy WebLinkAboutHomestead_Lemmons (2)CLAIM FOR HOMESTEAD PROPERTY TAX
i�? STANDARD/SUPPLEMENTALDEDUCTION
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INSTRUCTIONS: See reverse siCe /or filing ins'uWionS.
NOTB TelapMne_Sodal Secunty, tlriver's lirenre, staje idenGfica;qn aridlederal idenGficafion num6ers ara
FORM
HC10
I(�'e) �lAl N/O�{A XX `J �%,�`i�1 A 1 /VCt- cerlifY that I(we) oG7�Di�d �'U' �H�Y�
place of resitlence or am (are) buying ;he following described real property under conVaa for which a Homes:ead Property Tax St
Deduction is hereby daimed on ihe da;e ihis applicalion is signed, (da.e ' natura . I(VJ ):
❑ Own. ❑ Am (are) buying urWer recorded canvaa.
O Am (are) entitled m occupy as a tenant-stockholder ot a cooperative housing corporeGonGIBSON CO�INTY AUI
❑ Have a benefival interest in the Wst or ihe right to occupy ihe pmperty under ihe terms of a qualified personal residence
❑ Am (arej the shareholtler, partner, or member of the entiry Nai owns the pmperty.
It tr.r'ryg m mnraq Fee Svnqo cwneh iume
Recatle/s o.^.ce where cm'.rad ia recoNeC
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� a^Y W�'+� ot L'e resitle�f.ial s7ucture w Ne IaM rv�t eacee0vq ane (t) aae tlut-. xEiY.Ny Fu�ouMS Nat s:n[ture is uuE ro P'�%wx Ecaoe.OnaiCe tM �se aM_ W�tim
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I hereby certify the above statements are :rue, cortect, and comple;e.
numDCl BMYIBBI, tlly, 9d:E, dN LIYCOCB)
S� �%N/JJ3R71�5 H�l[5 R1J
Land not exceeding on¢ (7) acre
OMer WnE
Total IanE (line 1 plus lina I)
Rasidenual improvemenh or D.velling
Annualty Assessetl Mobila /
ManufacNr¢E Home Garzge
Topl improvemen6 (line 0 Nmugh line 6)
Taqlvalue (/in¢]pl(sline7)
I hereby certify the abov¢ Is trve, correcq
anC complete.
Veif�'vg aGion - Siy :a;ure o1Pytl.:w
20
lhal
irof
pay 20 _ Lesser of 60% of Ne assesseE value of Ue �wnestead or 545,000
xling any otherpmvisioq Ne sum o7Ne OetlucGOns provlded in IC G 1. f-12 fo a rtrobile home
�ssessetl as real pmpeM or to a manu(acfuretl �w+re that is nof assessetl as real pmperty mey
oue-haH(f2) o! fhe es.ypssetl value oiNe moble home w manufacfurad hwne.
DISTIi16UT10N: Ongral - County RuCi�. Fio-SanpeE Cory - iazpayet
Is daimantratatirig a
�J Yes � No
d any (wmDerartl5+va[ ory.5a9.
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