HomeMy WebLinkAboutHomestead_LamarCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hclo
State Form 5173 (R6 14-03)
F 1
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instructions.
I (We) /�/ GUUn Q� \ /10 Z �% cert�y�haton�t a ist day of March, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property T/ edit is hereby claimed:
' GBO
(We) owned � buying under contract IB N COUNTY AUDITOR
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
.: rFS.._:.: v'+ v [:'- ,��- �17x'.°v:�`i7CONTRACT.' RECORDED .:�i:, s??� "sFS's+.'.mfi
.�ue.......�:t�.K
If buying wy gn act, Fee im le owne
Recordersss office where contract is recorded Record number Page
', �` b_` �rt+ e.=` x'.°" r,. 3fi�' r_=" ti��..!.. s'.' �`.$% �rai"+ r�.. ':' =La`,»SPROP,ERTY:DESCRIPTION F�' "�?r ,�`.�,i7�?!- •��`",5�,t.."i -_� ,��r�'i?= +?�.E�`'
County
Township
Taxing district (at' town,tewnship)
Parcel number
Legal description
Is the pro rty'
uestion:
-
�+�
{+�.«a.°1VALUEa..c'a.. ,+`•
Land not exceeding 1 (one) acre immediately
I property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds 1h smlca ro is used to produce income, describe the use and potion
of the property utilized to produce income.
4J 1 _ jz _W/ O
__'o,`'a°s ;;� - "I *s. 4P,ROP.ERTY.OWNED''B1' CLAIMANT :IN'.OTHER'COUNTIES+'ur'. W_,AsL_°'
County
Township
County Township
I hereby certify the above statements are true, coned and complete.
ignature f da ant
Address (number and street, city, state, Zip code)
�•"� +���""x".nu',�'d `�'`7 ;
TRUEaT r
ASSESSED VALUENOMESTEAD
NµRESfDENTIAL J+.
SSRivPU.SONLY y- .iT'�a,'�u.VAIUEr,h:"'AT
100 %'OFjTTV.IESyVALUEr.,;�..
�+�
{+�.«a.°1VALUEa..c'a.. ,+`•
Land not exceeding 1 (one) acre immediately
;
Ka'�.. �31 i
surrounding residential improvements.
(1)
' '1'-�O- T
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
.s bay .r
.x-
'Residential
improvements or Annually
Assessed Motile / Manufactured Home
Garage
(5)�xc
OPINION "`'
Other improvements
(6)',ir;�x_rt-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action . Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Date signed