HomeMy WebLinkAboutHomestead_Houdyshell, CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
SLite Fortn 5473 (R6 / 1-03)
PreSCribed by Ne DeDartmenl of Local Govemmenl Finance
INSTRUCTIONS: See reverse side Iorlilmg instiuclions.
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FORM YEAR
HC10
' '� 'I _ .i � �.
,�. y _ 1: �� ��J 1��
I(We) \ certify�that on the 1st day�of March, 20
I(We) occupied as our p cipal place oi residence the following describ real property for which a Homestead Property Tac�CrediVis hereby daimed:
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❑ I (We) owned ❑ !ve buying under wntract � � �.�;,... - - � -, - , •;�- ;- ,
' Have a benefidal interest in the entity that is liable for the property taxes on Ihe property and Nat owns the property or is buying under a wnVaU.
If buy'vg om m�irad, Fee Simple owners name
Remrdefs office where contraIX is recor0ed
Counry
Township
disiritt (dry, fown, lownship)
Record number � Pa9e
PyFeIOn�GerV �� O O W I L����v� I a a ��..�0�'��`�nReal DroPeKY ❑ Mobtle Hano (I.C. 61.1-7)
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H any portion of Ihe resiCential 5W cture w the land nm exceeding one (1) acre that immediatety wrtounds that swctura is used to produce imm�e, desuibe Ne use and ponbn
ot Ihe proparry uU7ized b produce iuome.
County
TwvnShip
I hereby certiy lhe above statements are W e, coned and complete.
(numbe� eM s4eet,
Land not axceeding 1(one) acre immediatety
surrounding residenlial improvemenLS.
Other land
TUaI land (line 1 plus line 2)
Dwelling
i� 1
l2)
(3)
(4)
Residentiel improvementa or Mnualty
Assessed Mobile / Manufactured Hame Garege (5�
Other improvements
Taal improvements (line 4 fhrough line 6)
Tdal value (line 3 plis line n
I hereby certify the above is W e, corred, and
complete.
Veti(ying action - SignaNre ofALdiWr
(6)
(�)
(6)
SignaNre ofASSessor
Tavnship
Date signed
Date signed