Homestead_Smith (16)CLAIM FOR HOMESTEAO PROPERTYTAX
CREDITISTANDARD DEDUCTION
Sfete Fortn 5173 (R6 / 4-03)
Resaibed by tlro DeDermronl d Laal GovemmeM Finance
INSTRUCTIONS: Sea ie�era� sf4lorRip imbudipnt.
FORM �J YEAR
HC10 �
� .� � �1.J
I(We) °� . certify that on the tst;daq of March, 20
a//,. fs/�-�
I(We) occupied as o 'ncipat place oi res'de ce following descnbed real property for which a Homestead Properryvmc Credit rs hereby daimed:
'�(VJe) owned ❑ Are buying under contrect GIBSON COUNTY AUDI70R
' Have a benefidal interest in the enfiry that is liabie for the property taxes on the property and that owns the property or is buying under a contraU.
If buyinq om m�irad, Fea Simple owners name
Remrdefs office where conVaa is recorded
x'f�°s.�'��C?:'�=-;.ki.�HS_=�.. +�i'Gr��..: ��
Counry iamship
Parcel number
UU �—c� i 7.� -� -�-c� i� ncaac v � J�
tl any poAim ol the residentlal sW cWre w the land na azceeding one (
or me property utifaed m produce ifrcome. �
I
Record number � Page
(�N.
I Is the Oroperty in qLeslion:
❑ Real D�opery ❑ Mobile Homo (/.C. 67.1-7) .
wrrounds ihat sWUUre u used to produce incorne, desmbe Ne use and portion
I aG - �a . 3� _ io�--c�� �.� o�� � a I
20 _ Pay 20
Lesser ot 1/2 Homestead
vauanon a f35.000
5
of Auditw " � Date signetl