HomeMy WebLinkAboutHomestead_Thompson (6),..,,
E °a CLAIM FOR HOMESTEAD PROPERTY TAX
;��: CREDIT/STANDARD DEDUCTION
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State Form 5473.(fl2 / 5-92�
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INSTRUCTIONS: See reve�se side 7or liling instructions.
FORM 1'EAR
HC10
� � � � � C TI ATION STATEMENT ' ' �
� Ne) � certifv that on the 7 l da f arQ�.. ei�Z
pied as our principal place of residence the foliowing desaibed real pr perty for which a Homestead Pmperty Taz CrMed�ii is hereby davrl�E
r I(We) owned ❑ Are buying under contraci �- � _ . � '"'� ll 9 IJJI �
❑ Have a bene(icial interest in the entiry that is liable for the pmperty taxes on.the property and that owns the property�s buying under �yontraci.
If buying on contract, Fee Simple owner's name
Retorder's ofliCe where Contract is recorded
RECORDED. ..
Record number � Page
�- PROPERTY DES IPTION � '
Counry � Township � - • � Tazi g di rict , ro rownship) � _
r n ber _ O Legal tlescription ,
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If any portion ol (he residential structure or the IarW not exceeding one (1) acre ihat immediately surmunds lhat sWCNre is u5ed Io protluCe i�ome, tle5cnbe Ihe use antl portion
of ihe properry uiilized to produce income. .
e • .� �
Counry
PROPERTY OWNED BY CLAIMANT IN OTHEH
Township Caunry
� certify ihe above statements are true, correct and complete.
(number and 5treef, uty. State. ZIP code)
�.#3 Bex 198►i �k�,.xc� �e�
Uaimant
, ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE - -
Land not exceeding 7(one) acre immediately . -
surrounding residential improvements. (�) �
Other land (2)
I
Total land Qine 1 plus line 2� (3)
Dwelling (4) - � �� �
Residential impmvemenis �
Garage (g) -
Other improvemen[s (6)
Total improvements (line a through line � (7)
Total value (line 3 p�s line � (g)
I hereby Ceriify Ihe above is �rue. torreCt, and Siqnature ot Assessor Date signed
complete. .
�ing action - Signature of Auditor Da;e signetl
19_Pay19_
Lesser of 1/2 Homestead
Valuation or 52.000
S
ALLOWANCE
l�t/:IS'�/1�.1nI"� ��