HomeMy WebLinkAboutHomestead_BeloatN CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC70
y State Form 5473 (R4 18-00)
INSTRUCTIONS: See reverse side for filing instructions.
1 (We) T" A (oJ� certify at on the 1st"rc., I.(We) occupied as our principal place of residence the following described real property for which a Homestea ar / GIBSON
J,:e) owned ❑ Are buying under contract e 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.
: =. GONTRACTaf2_E_ CORDED '��``ve
It buying on contract, Fee Simple owners name
Recorders once where contract is recorded - Record. number Page -
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�` ��.-": �t; �3'?? PROPERTjY�0E5CRIP, �T10N- � `s,�•- _�w�f,'•��`i�E•"'�'�"a•�" �' _
County
Township Taxing district (city; town, township)
P I n mb O ar
Legal description
It any portion of the residential structure a the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
0 the property utilized to produce income. '
e
�v,a'"''��++''`•:^t'
8Y— ;CLAIT?IN?OTFiER COUNTIES-- "✓pa'�,�"jas�'^`vy:.,)
'',- _`u"`'' PROP,EfiTYrOWNED M_AN L - f
�- --
County
Township
County
Township
'I hereby certify the above statements are We, correct and complete.
Signature o aimant
e
(number andstre
rate, code)
` -
L4 0
3 -'�•` A -.• a -
surrounding residential improvements.
�, ^` - °�' t�3f
xs�`fIWSS SSOR N` E OINE' 5 '-= %
6TRUE'•Tf,Jt�
YASSESS VEDA' ALUE -;,I
HOMESTEAD._
i-'
f ONT- RES3DENTW
-
VALUE .
}1 {Y��x.,...w�-du�.
AT:'100 %'OF'TTV
Ku
VALUE
M— re:•acv.i..`.�7-_:
VAII
�x,:t;"' _ 1. _
Land not exceeding 1 (one) acre immediately -
3 -'�•` A -.• a -
surrounding residential improvements.
(1)
c -2 � -
Otherland
N �:iriF kii -
(2)
t
CON
Total land (line 1 plus line 2)
(3)
Dwelling
(4):'-n�
_
Residential improvements
Garage
_
(5)'�`.y,,,fi
- -
Other improvements
(6)
'.r+?:. •- r•='s.;
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature ofAssessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 12 Homestead
$
Valuation or $6,000