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.�� � CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
` J State Fwm 5473 (RS / 10-07)
°i� Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side lor (iling ins(mctions.
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FORM YEAR i
HC10
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I(VJe) �J � LI1'Y(.��J _p,�f ( A certify [hat on ihe � st day of March, 20
I(We) pied as our pnncipal plac of residence lhe following described real pry��rty for which a Homestead P erty T�c Cre it is ereby me
LR'I �e) owned ❑ Are buying under wntracl v
GIBSON COUN �'�" ����TOR
iHave a benefiaal interest in lhe entity that is liable for lhe property taxes on the property and Ihat owns the pmperty or is buying under a contract.
j"c-:.=�'-',<3�♦..Z';�' ''�..�:_ ��;,-r ,,, �-;'�:��;.i..�.CONTRACTBECORDED�•�:.. � . ,
y.
I( byvg on contraG. Fee Simple owners name
Remrdefs otfice where wntrscl is recorded Rewrd number Page
Counry
Parcel number
Tavnship
/9-3-�D
IP.TION ! ', -: _-•� %��;:��
dislrict (tiry, fawn, fownship)
15 ihe O�operty
DroOerty ❑ MobilaHOmoll.C.6f.1-7)
If any po�ion of Ihe residenfial structura w the Wnd not exceeding one (1) acre that immediatety surrounds that sWCture is used ta protluce income, describe Ne use antl ponion
ot the property utiGzed m produce income. S��
l.!
� ��-'� �. 4+=` j'�' '^- � r , .. � - - �=PROBERTY OWNED BY CLAIMANT IN OTHER"COUNTIES � � °� ::ti � �;. `'."_,., �'r -' ' �' '�'
County Tonnship County Tavnship
I hereby certify the above statements are true, corred and complete. Si amre ot claimant
�ress (num6ei aM street, ciry, state, ZIP code)
aa ;x-+�.s-. .�c=.7 � -p �.'� -a 3,v . g _ _ . . . .. , f. .. _ . . z .-s �.
'� �figF' �ASSESSOR�USEONLY � E � - �a_TRUETAX : '��� ASSESSEDVALUE +HOMESTEAD •� �- ;NON-RESIOENTIAL�
s�.'=>e`.'���,t:.,'=:3t Y-. .-_z:iP'_ � ���` - . VALUE_ 5 =''AT100%OF.:TN . y�,'.VALUE� � � - •VALUE . ' %''+. ?%is
�.-_�:. :� 'P� �.:.. 't � J ..y..:.� � .
Land nol exceeding 1(one) acre immediately '� r ws-� "" 4� r"� 3`-.:�>
surrounding residential improvements. (� � "��, �-� �; � K; �,� �-'
;' A .
Olher land (2) -,� � ��:
_ , 1
T�al land (line 1 plus line 2) (3)
... , t �- � �.4
Dwelling (4) i -a 7�"-s�� si Y��' �T ..
Residential improvements :;� Y�'� F,�u �`'' ��"'y� E'
.�SF "�'.i•s F.:as""� .Y�'�, � ._
Garage (s) _�a ��zi,'a;���i'-;:r:;?'���ri-':
F,Y �l
Otherimprovements (6) ( { � � � ` �.r
>
.s. ?.r,_.m...
Tctal improvemen6 (Irne 4 fhrough line 6) (7)
Tdal value (line 3 phs line n (g)
I hereby certi(y the above is W e, conect, and Si9naWre of Assessor Date signed
complete.
Vrrifying actan - SignaWre oflwditor Date signed
. � '-' ..'�:'_`—,� _-� `�,4`.'Y. � �- . -��'•'
��'4'`'3Ts�=•= ��.�rTF ?.. ,: �� ��;;��`�.,��.-<:STANDARD.DEDUCTIONALLOWANCE`._�v„"�....,�_:.�.- � ,.- .,� ... .
20_Pay20_ .
Lesser of 12 Homestead
Valuation or 56,000 5
Signaturo oflwditor Date si9ned