HomeMy WebLinkAboutHomestead_Barrett (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
♦ State Form 5473 (R6 / 4-03)
Presailted by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
IF M YEAR
H 0
JUN 0 6 2005
46'vs clu'vi
I (We) liz )/(ZM01 certify t6t opo ' 01146h, 20
I (we) occupied as our principal place ofresidence the following de4scnbed real property for which a Homestb&PQpeCrk Tax Credit is hereby claimed:
L'�q (We) owned ❑ Are buying under contract
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.
2 :v kV - I WWT 0 INITRACT, R EC 0 RD E OWN-ft
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
County Tcwnship T d qV (city "
to, township)
Parcel number Legal description Is the property any in Question:
61,2- ��Ilproiperty ❑ Mobile Home (/.C. 61.1-7)
If any portion of the residential structure or the land not ex9fleeding one (1) am that' edi tely surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce, income.
ev-
V',t �-' PROPERTY'OWNEC;BYCL:AJMANT=IN'OTHEFi tOUNTIES�L�-'
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Slgnatu of claimant
(number and street, city, state, ZIP We)
615'E'�' —*4
-TRUE ,TAX
'�-.NON 'RESIDENTIAL:�,-,-, -i
,�ASiE �Uf4o
Land not exceediqg 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
5
improvements
(6)
.Ogbel
Total improvement (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $35,000
S
Signature, of Auditor I Date signed