HomeMy WebLinkAboutHomestead_KirbyCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
.', State Form 5473 (R215-92)
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INSTRUCTIONS: See reverse side for filing instructions. A n
I (We) 1 I k' r o c�-- certify that on the 1St daqftarca C
111 "e) occupied as incipal place residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
{We) owned ❑ Are buying under contract
J 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 unWUAZ
CONTRACT RECORDED
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number Page
ASSESSOR USE ONLY
ASSESSOR
PROPERTY DESCRIPTION
County
Township
Taxing district (city, town, township) -
Parcel number
Legal description
C> b0003-6
It any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
(2)
-/3- o- /D /- ck-140.as3 -064
ASSESSOR USE ONLY
ASSESSOR
TRUE TAX
ASSESSED
VALUE
HOMESTEAD
VALUE
. NON-RESIDENTIAL-
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Other land
(2)
-
Total land (line I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(6)
I hereby certify the above is true. correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 Pay 19_
Lesser of 1/2 Homestead
Valuation or $2.000
5
Signature of Auditor
Date signed
FAI