Homestead_Wallace (2)° CLAIM FOR HOMESTEAD PROPERTY TAX
•. -�> t CREDIT/STANDARD DEDUCTION
` State Fortn 5473 (RB / 7-07)
�w 1 Prescnbed by lha Department of Lxal Govemment Finance
INSTRUCTIONS: See reverse side Ior filing instiuctions.
FORM
HC10
���-�✓ �
YEAR
I(We) �1 /� CQ/ / (- �(JL� !'r' (.�/ (L1/J/�[�__ (/ certi(y that on the 1 st day of March, 20
I(We) oocupied as our pnndpal pla— ce oT nce Ihe following described real property for which a Hom�� pQrty 7a� Credit is hereby daimed:
N /3a��1
e) owned ❑ Are buying under contraU GIBSON COUNTY AUDI
Have a benefiaal interest in Ihe entity Ihat is liable fa the property laxes on Ne property and that owns the property or is �g under a contrad.
If bydng om m�traq, Fee Simple o.vnels rroma
Racordefa office where contraq is recorded
Counry Tawnsltip
Pa¢el number
It any portion o� the residential strucWre or Ihe land nol exceeding one (7)pp cre�a}
of Ihe property uU5zetl In pioduce income. / Y
/
Recwd number I Page
I Tacing di 'sfqcl f�y,/p:m, to' �
7 �'I
_/� I Is Ihe property in queslion:
❑ Real property ❑ MoGie Home QC 64J-7)
ir9m�ately surtounds Ihat sWCWre is used to protluce inmme, deunbe the uu and portion
� �o-�� ��-� �-Oo/ �J ,
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. . .. . .
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Land not exceeding 1(orre) acre immediately ' %� �� �.� �:`
surroundingresidentialimprovements. (�) -��_i;�`e_,�: �'s� �-'
Otherland �z) � �
Tcfal land (line 1 plus line 2) (g�
': �- ? . _'_ 4 t _ ±. .
Residentiai improvements wMnualty �eliing (4) ;�T „F.y. -.:^ ... _
Assessed Mo6ile / ManuFactured Home - � ='•. -= - --: i`.� .
Garage (5� - -_ .,,._ _ . � _..
Other improvements (6) � - .
Taal improvements (line 4 fhrough line 6) �7�
Tdal value (line 3 pha line n (8)
I hereby certify the abOVe is We, wrrect, and Signawre ofAssess« Date signed (monN, day, yea�
comp�ete.
Vuifying aaion - Signawre otFwdimr Date signed (rtrcnN, tlay. yeah
� �.-� � � • •
�— FaY Z� — 45.0pp for 2007 pay 2008 42.000 for 207 0 pay 2011
Lesser of 12 qq.000 for 2008 pay 2009 47.000 for 2077 pay 2072
Homestead Valuation S
« 43,000 for 2009 pay 2010 40,000 payable after 2072
Signature otPUdbr Da1e signed (rtronth, day, yea�
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