HomeMy WebLinkAboutHomestead_GriswoldCLAIM FOR HOMESTEAD PROPERTY TAX FORM _ YEAR
s CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R6I4 -03) !i ,
Prescribed by the Department of Local Government Finance _
INSTRUCTIONS: See reverse side for filing instruclions. MAY 2 1 2004
certify
Ih
aVon the /11sl dayof March, 20
(We) occupied as our principal place of resyen the follow)ng described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ 1 (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.
".a`+rs2— r'.irCONTRACT.' RECORDED 's2�- a"'sy.''°sr.F,..sg`
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
...,b�� P ,ROPERT.`/.DESCRIP,TION,r.��:x
County
Township
Taxing district (city, town, s ip) Aarbdw
P7I Itt)atbeer
Legal description
Is the property in estion:
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eat property ❑ Mobile Homo p.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediatety surrounds Nat s re is used W produce income, describe the use and portion
of the property utilized to produce income.
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-.' i�` �..`-•-_'', �'.°' �i��?` iPROP. ERTYOWNED` BYCL'' AIMANTINOTHER 'COUNTIESI�:•,.•'�„`�: ,_ � �,�EF%�,,� -��
County
Township
County Township
I hereby certify the above statements are true, correct and complete. 1i
Signature of claimant r
L.Jetre number and street, city, state, ZIP code) _ r
A 30 , D s c o —241476
yASSESSOWUSE ONLY• ?�
TRUE ?AXKKK
ASSESSED VALUE
S.a_u+�
sHOMESTEN i<
VAL'UEC
NON 2ESIDENTIAL
- x is�
`QVALUE
%'OFTTV
_ 3.,_-
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itu•_
Land not exceeding 1 (one) acre immediately
(1)
;rlfi
�' SVw
surrounding residential improvements.
' V5?=,
ti. -V`*
Other land
(2)
"F4;
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
s" I g ;4
r.,J � .e'�S�>= -tF
Residential improvements or Annually
Assessed Motile / Manufactured Home
Garage
(5)
" -R, 1
.
01
Other improvements
(6)�'
# %'.
rrj;.,
•. a
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
1 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
Vau)AUon or 535.000
3
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