Homestead_Alexander (3) STATE FORM 53569(R318-10) TREASURER FORM TS-IA
APPROVED BY STATE BOARD OF ACCOUNTS,2009 PRESCRIBED BY THE DEPARTMENT OF LOCAL GOVERNMENT FINA:CE IC6-I.1.22-8 I
_,;
�. ' CIAIM FOR HOMESTEAD FROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Stete Porm Sq3 (RBl4-03) �
' Presaibed by Ne Deperonem ol Local Govemment Flnance
s:
INSTRUCTIONSr See reverse �side /or (ling instructions.
FORM YEAR
HC10
,�, � � /►
I(We) certify that on the 7 st d y�1.larch, 20_
I(VJe) 'ed as our prindpal place of residence e foilowing described real properry for which a Homestead Properry Tac Credit is hereby daimed:
�7 I(We) wned ❑ Are buying under contract
MHave a benefidal interest in Ne entity that is liable for Ne properry taxes on Ne property and ihat owns the property or is buying under a contract.
I( buying on conVep, Fee Simde awneYS name
Recordefs oftice whera wnvact Is rewrded
Counry
v��t-�� ��-�� rt�1. �� -�-��
If any portion o( Ne residantial sW cture or Me lard not ex �ng ona (t � aae Nat immedial
a ma wopero omkea w v�oduca i�cane.
�25 5ac�
- - :.i "k s°_
Rewrd number Pape
21P.TION�-••�• r. ,:..� 'ft �, - .�<'`i�r>,: .
7 ' (q(X.feAn. towruhiD)
Is iha pmpeRy in Quesdon:
❑ Real property ❑ Mobile Home (I.C. G7.1-n
surtounES Nat sWCture is used to praduca income, desuiba Ue use and partion
' °"� � �.'': '�`.�-t.�r.. �We'�.�.`^_�.`'�.-X.-�'�`.,�PROPERTY.OUVNED:.BY;CL/UMANT;IN;OTHER.COUNTIES:c.Jh?„�-5,ri.; it2?^,: t _.°..�;S�Si-r2 -�.� .�?:� ��.?�?":
�. e �" �ti�S•t� a r -
' �': �l .e'+...?1 -�SCr.-
Counry Twmship County Twvnship
I hereby certify the above stetemeMs are We, cortect and complete. Signature ot Geimant
dresa (number and sUeet ciry, state, ZIP code) �
�i'- ti:i„ cc.x � S"�r� � Sx^.0 ��@ �:: _4tHi � - c� �ry-r� . . . - . :A w . .. G :
e, F'T �ASSESSOR USEFONLY'� �'�'""'�� z� ,_, iTRUE TAXs A5SESSED�WILUE sHOMESTEAD ;.F .. yNON"�RESIDENTWL.,� �
.��?rerr`:�'.�r:"s.aY:.-.t�-�°w:.?iai�-3!�',�--?._.�-�; -', � VALUE'�` ,. AT;t00XOF1'TY f.--�.'VALUE Y' �::� S,��V/LLUE _�""'_.�`-$t_"`
Land not exceeding 1(one) acre immediatety ;�;}'� � 1'.,;r �"* ° r"�3+n �:�.:
surrounding residential improvaments. �� � - ,"� „r.,;�' � � , ��*
� ;i '� -+ �, _ "
Otherland �y� � �
Tatal land (17ne 1 plus line 2) �3�
� Dwelling (4) a�..�e �Xfi;g''�{�r'—*�k`�,'
Residential improvemenLS or Mnualy ;;,r-�"`t�.�.;: �'s � H F -:��
Assessed Mobiie / Manufaccu2d Home �w 4,..� i.�_ z�'• �'
� „ Y-'w �.�+s .i�.,
GaRge �$� � h -.�` �;� 1 ., -. 4s_y'<C-�ti.i..
O�hei improvements (6) , ,T�.Y` ,2.,-�
,�:
To[al improvements (line 4 through line 6) �7� .
Rfal value (line 3 phs line n (8)
I hereby ceAify the above is We, correct, and � �e�ad� a��� Dau signed
wmpleta.
Vailying actian - Signalure of Audita , Data signed
't.�`.�.`�'1± o��=�n �i�-:-:':�x-c?�4�`:'?�Gn�._t'#.;�.�-sSTANDARD:DEDUCTION'ALLOWANCE. .�.. � '.izt�c.
20_Pay20_
Lesser ot 1/2 Homestead
Valuation or $35.000 5
SignaWre af Puditor Data signed