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� t CLAIM FOR HOMESTEAD PROPERTY TAX
- � CREDIT/STANDARD DEDUCTION
`�� J Slate Fam 5473 (RS / 1D-07)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /or (ling insl/uctions.
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I(We) occupied as our pri ipa� place f residence Ihe followin9 d scribed real prop rty for which a Homesfead�mperl�i 7�Gedit is b@reb.yiiaimee
� I(We) owned ❑ Are buying under contract
�Have a benefidal interest in ihe enlity ihat is liable (or ihe property Wxes on the property and ihat owns the property or is buying under a wnVact.
I( buying on conVad, Fee Simple owner's name
Remrdels office where contrad is remrde0
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County Tavnship
Parcel number `� Legal descnption
"lf� f_ � c`�� c�f .
Is
If any portion ol the residential sWdure w the land not e:ceeding one (1) aae Nat immediately wnounds that
ot the properry utilized tn produce incame.
Recard number
township)
Page
quesGon:
¢eal pmparty ❑ Mobile HomO (I.C. 67J-7)
re is used to Droduce income, describe Ihe use antl portion
) "b "Y��� T�' 1 �'i � ^'i)�e - Y�r l Y� { (+:�ita
�'� � ' ��0..3 � TRUETA7C � ASSESSED VALUE HOMESTEAD '`� NON-RESIOENTIAL �v7
��� Q�xASSES50R�USEONL���y�..�.F.�Y,y�VE�� �-AT�700%OFTTY„s�VALUE��G,�s��ypLUE..l,.�.:,�,���
f`. 1�'--=:i.�C':.�3a,_P'_s�.��'n5-s���:.� '�k,i L . '�d: .ro�.a..-»,
Land not exceeding 1(one) acre immediately a;7}�f.,,�"-n,�.'x5�� R'*�yt�.,-� °��a.f�e;
surroundingresidentlalimprovemenis. (�� r*��.'���P„r��Y .���3�_.4
r � ''AHS3 i °'�� �
Other land (2) ��,� �•�
w
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Tdal land (line 1 plus line 2) (g�
�: "4 „F a�x`Y-7 µ i y=�sai'U"#
Dwelling (4 i-'�;,� rg�_�°rs�' '`'�
ResidenGal improvements � �����*������'�����
Garage (5� ���,t��t; :�,�aa�a�g���.
�'�a"'�' " � .4�-�r�*'
�.,�:���'._ '-���s
Other improvements (6) �-�`�� �;. '��'i
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TUaI improvemenLs (line 4 through line 6) ��)
7Ual value (line 3 phs line n (g)
I hefeby certi(y the above is We, coned, and Signature of Assessor Date signed
complete.
Verifying action - Sigrature oflwdiWr Date signed
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� ' a:�'��.-� 3''��� �if?.s �<�`3�i`�."�.t� �STANOARU:DE�UCTION ALCOWANCE � -�;,'� .�a��s�.' ��`-'.'#�`�._-,:.��+,�.�+:�'<�s� R�.:-..:F
'� 20 _ Pay 20 _ -
Lesser of 1/2 Homesiead
Valuation or $6,000 S
Sgnature of Auditw Date sig�nM(
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