Mobile Home_Fougnies (2) (Ft" • a
v�; CLAIM FOR HOMESTEAD PROPERTY TAX / FORM
1:.. CREDIT/STANDARD DEDUCTION I/// HC10
`!i�? State Forth by the(De l Department R h
Prescribed by Ue Department of Local Government Finance .legal
INSTRUCTIONS:See reverse side for filing instructions.
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�1l .a�-. - . _ ',.. .-- a.. .4 CERTIFICA_RON:STATEMENTt?+',iaz,��arm,,,; , IAlliV(Wil))IJea ='f-.'-
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I(We) - �., • _en ' _.•-•r. __._;___ • /'Certify that o the tst day o-Mart.20_
I(We)occupied as our principal place of residence the followin:•described real property for which a Hog es e.d P[opf op ' r y claimed:
❑ I(We)owned ❑ Are buying under contract GIBSON COI RR Y AUDITOR
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
+�sv ta.- . . -V';."P• r: ;,:r.�yiyy iCONTRACTRECORDEO :.._z :a>` .Ir rater a +.s
If bu'y/)ng-on con d Fee S' pie owneYs name
R rders office where contract is reeled •U Record number Page
a%; -.44S-3i ",_-•c `:z. ::-.4-' .ty -'.�+. .. %I-S-70ROPERT'<fiESCRSP,TION 3 j by Tli.'' - `'. _. ', + `l
County Township Tain• disAn(a7y,town,/township)
Parcel number 1.4 a'8 Legal description Is the property in question:
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• — OW '' -CV ❑ Real property bile Home(LC.6-1.1-7).
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
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�tltNn;.�is,' -.:_- ..r: `'``d�'��t- EP,(tOP.ERTY;'^OWNED,BY�CLAIMANT.IN�,OTHER000NTIE8wr-errs .,--:++?w��:1r«_'�i�'?-s�°'if'"�-Fy4" t#
County Township County Township
I hereby certify the above statements are true,correct and complete. Signa claimant O�
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�ress(number and street,city,state,ZIP code) (,/J
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+. " 'a' '°` -d s TRUE TAX ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL_
' ASSESSORIUSEONLY 'w- VALUE• .1AT 41000%'OFTTVJ �'AVALUE, ¢ ' s VALUE)r- ,
�Yri,'1s5- , - -1`.`. .24.-r mss ,•.d�d,, .� � „r„ ,,. a:.e.. dSrC'€TC:.._..... «��s'si..--+.�«
Land not exceeding 1 (one)acre immediately -..�� .� =w '
is `_
surrounding residential Improvements. (1) . a-?':: •
Other land (2) v,' �'
( ) az
Trial land(line 1 plus line 2) (3)
Dwelling (4) 'Ir. r --- ss- - ,r''+i'-,-_
Residential improvements - 4-. " y
9
Gare a (6) Y4.•�' ,tt .'rt "?1s
Other improvements (6)
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 plus line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
c?. gaWa $ 0f{s'ia67ANDARO DEDUCTIONIALLOWANCE*WaSi T�-�'r, t` ';"i „ ?. i ' .
20_Pay 20 _-.
4- n\\.. Lesser of 1/2 Homestead d '/�11\ -
V ” Valuation or$6,000 \ \ \ \ $ 1 `\\ 2
Signature of Auditor i Date signed