HomeMy WebLinkAboutHomestead_Thomas (12)CLAIM FOR HOMESTEAD PROPERN TAX �� FORM 1'EAR
- ' CREDIT/STANDARD DEDUCTION ^' NC7o s�
�1.. ^� � Sfate Fortn 5473 (RS / 10-01) ��
yw �\�
Presaibad by the Departrnent of Local Govemment Finance y
INSTRUCTIONS: See 2verse side for filing instructions. �
.��rtG�".��r'`='�s'�'.f:. �' .�......N,'�=''a���"���.� �CERTIFICAiION�STAlEMENTr`f'fa?*�i,�,,,,"`."�fu�"`:�'�.=i?ti�=..s�"�``?��?' _'�" `i�'°�i.
i�we� T/�D �7 ✓�S �,Q Ae�'�/Y� /�,�T �A .1 ��o yd certi(y (hat on the 1st day of March, 20_
I(N/e) occupied as our principal place of residence ihe following described real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under co�tract
Have a benefidal interest in ihe entity iha[ is liable for the property taxes on the properry and that owns lhe pmperty or is buying under a contraU.
If byMg on conVact, Fee SimO�e owners name
Recmdefs otfice where conVacl is remrded
Counry
Par�nu/ � ' � / � ^ D
/ / oC
Tavnship
Legaldestription
Racord number � Page
Tacing districl (ciry, town, fownshiP)
Is Ne propeM in question:
❑ Real prooertY ❑ t�AUbile Homo (I.C. 6/.
If any portion of Ne resitlential strucNre w the land na exceeding one (1) ace that imrtretliatey wnounds that swGUre is used W produce income, descrihe Me use and portbn
of fhe property ulif¢ed tn praduce income.
���<;_��'`"�����'�:�'-�`-�`,�sPROP.ERTYi�OWNEDjBYwCL'AINIANT IN���OTHER"COUNTIES,`�e�= .��.�.�?��_�'.-n'}�`*�.�.c��'4�Pr'"��
County Tawnship County Tavnship
I hereby certify the above statemants are W e, corred and complete. Signature ot Gaimant
�dress (number aM sVeet, dty, sfafe, ZIP cade)
������-s.s ���V�ONL'h�i���"TRUETAX�� � ASSESSEU�VALUE �HOMESTEAD� r'�' N`yRESf�EN�U1L�`�
,������. ��-�,�``�._�,,,,�'� �VALUE,l�� : ATw100%AFTN� � VALUE�� ���w��?�; VALUEf�,�,��
Land not exceeding 7(one) acre immediately '"�'�' ��.'��"�,.'��'��i��`"-�
surtounding residential improvements. ��) � �s<,��`',�§e,��, �r�; ���
rt��E?" l=ii_'n .. .
Otherland (p� ; �J`�r'�+'.�'` `�
= iY�:�'=��
TUaI land (line 1 plus line 2) (3)
���� �7r fi ���"�,`�'�
Dwelling (4) �+�r.�.� �� �'�''., •Ct��'�.�'
Residentialimprovements �. _;,e >,.,
�"3 �ry�-y�F �j=�� � �
Garage (5) :�� ''' � �: F �
..� : '_�,�. as�
�.'> t•. i'
Oiher improvements (6) �Y��� �� -�
Z �; �=; 4 �`Y.. :. : --'�y
TUaI improvemen6 (line 4 through line 6) ���
TUaI value (Gne 3 phs line � (g)
I hereby certi(y ihe above is We, corted, and Signamre otnssessor oate signed
complela.
Vefifying action - Signature otAutlimr Dale signed
�.-..; =a�� ...r+*^� c �„��;STANUARU:OE_DUCTIONALCOWANCE:�vw�.��`.r3�.-.�`.�?#��.��-'�-"�i�i�`..3��a�.'*a��*�r
-���r�r__�saz'�'!�p''�4�'�.._'-�3c.� v _
20 _ Pay 20 _
Lesser of 1/2 Homestead �
Valuation or 56,000
Signature of Auditor � Data signed