Mobile Home_Leister �" CLAIM FOR HOMESTEAD PROPERTY TAX FORM
, ;. HC10
� ;. CREDIT/STANDARD DEDUCTION YEAR
altilid State Form by artme1
prescribed ed the De by the Dapattmert at local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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td Z�°et list✓�-n'•. t `gl `s A .s' - CERTW! TION STATEME l'+ ` . ...,,, ; ,,..,,,,..CU'.-_%... ..-�i rs
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I(We) certify that on the 1st day of March.b_
I(We)occupied as our p u pal place of residence the following described real property for which a tfokastepd1Prail Tax Credit is hereby de ed:
❑ I(We)owned ❑ Are buying under contract
•Have a beneficial interest in the entity that is liable for the property taxes on the property i that owns a prope or lepu ng under a contract.
+ LJ ' no L
/ GIBSON COON 1
. •! 4.%. ri:a e- rz ISMast'N CONTRACTRECORDEDa,,,. "`-fza°,' . .- ra
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page \`
F3.tr' -rt-r - -
�-=-K �n� ,���. ,�7`•� ><-w''ii'.3•.. tiP,ROPERT,Y OESCRIP•TIONI :`s�xsari =?��-�i.." �"�;�z '"eT-2d: '
County Township Taring district(city,town,township)
P u ber L-< Legal io •,� ' Pn �// Is the property in question:
r / ..6133-co i �,,ea �.fJ
ID Real property bile Homo(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.
.CG,. ;,;_=�.. "ir r=-r ''V'.,1, [P,ROP.ERTYiOWNEDBY,;CL''AIMANTiIN';OTHER'COUNTIES - _ "`x`°3�-3#t.-IZtt-. _ .
County Township County Township
I hereby certify the above statements are true,correct and complete. ignature or claimant C�,Js-;;te
Address(n _street,c/fijatq,ZIPt ) I ' Li i 6� </,�/ ��." • `,.,•-
V _\yl,Y^Vwl 10u.. 407.—S-
W; --.• - i • '' " TRUE TAX r' ASSESSED HALVE iiiipiTEAD " -NON-RESIDENTIAL ' f
ASSESSORer ONLY§ ' -s`a VALUEf _'?AT 100%OFoTTV ruts ,VALUES �5' „�.VAL!glAtS"
3.-.,�?i,3 'e1.r�'.=.�� _��r ^:�"'3l.us . =tie +�_.'e P�>_....
Land not exceeding 1 (one)acre immediately (1) r "' 417-75;11
surrounding residential improvements. w --.,
Other land (2) _ ;`g f£
a
Trial land(line 1 plus line 2) (3)
Dwelling (4) .
Residential improvements w- .. r-° F- —
( ) ' <.
Garage 5 ,. •: tea?.- 2-&
€.
Other improvements (6) : iii �t
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 phs line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
Ir. ntWE m`erC i'-- -si."l ` `,,`ST DARD'XIEDUC�ION"ALL'OWANCE --{a#'u+`;r §s iati asi`F.e s°3.atiTC t.ri``�{'kg ie?�yaw'• ?
®/ 20 Pay 20 k `\
\ Lesser of 1/2 Homestead \ \ rI (;��Valuation or$6,000 \ �`�\° /�
Signature of Auditor Date signed
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