Homestead_Wallace (16)��R, t CLAIM FOR HOMESTEAD PROPERTY TAX
''�-°� � CREDIT/STANDARD DEDUCTION
♦ J SUte Fwm 5673 (RS / 10-01 �
°i� Prescribed by Ue Department of Local Govemment Finance
INSTRUCTIONS: See reverse side !or liling insfrucfions. -
:�r � ;y`... +"- �: j7 ' -k- r�„y �-�� -, - �; j� ` -' : - :' CERTIFICATION STAl$ME,ryT =
I (We) i" i �/ l/
I(We) occupied as our pnncipa� place of resid ce the following described real pmpeAy for which a
❑ I(VJe) owned ❑ Are buying under wn�ract
�Have a benefidal interest in the entity that is liable for the property taxes on the pmperry a�
FORM � YE R
HC10 ��
cp:. .,
1st day o( March, 20_
: Credit is hereby daimed:
under a contract.
c � :. rr.3va .�:�'r`F �. �r� ,.C;s�.�.� ..�:.. �.,�:Y't.s'r.�:CONTRACT'RECORDED:��,:^., _ �"::�,. i'.._i :r_�� �,s�_- ' � .
If huying on conUaa, Fee Simple owners name
Remrdefs otfice where wntraq is recorded Rewrd number Page
Couniy Tavnship
Parcel number L al ' tion
O /9 -0/989 � 3
If any�portion oi Ne residential sWcture w Ne lantl not axceeding one (1 � aue that
of the property utilized tu produce inmme.
Tacing
Is the proi
�
surtoundsthal
�rv ,� : �q..tiy -
:-'sZi Z` - vM
township)
in questian:
'�eal properry ❑ bbbile Homo (I.C. 61.1-7)
ture is used to produce income, describe Ihe use antl ponion
_..'
��`'^25 T'�,�'rA SESS RUSEONLY �� ? ,.� �� _s}TRUE.TAX , ASSESSEDVALUE -� HOb1ESTEAD ' � ✓ NON RESIDENTIAL�''t�� 4�-
'�.te'.�.r u'.si. :."&��r-z;._,+� `'' e �a. VALUE-� v -�:AT.100%:OFTTV �a..... VALUE� � ��"' r%'t � :�VALUEn.+.:::'�; x1�
Land not exceeding i(one) acre immediately '� j r Y- r�` ��'> `� .
:
surrounding residential improvements. ��) -` ;'1,'�.,'��:^�=: _`-a�•>�-.:�%-� � � �'
Other land =i��y'�''� � � f'
�z) �r.t.�:,y- _.�`
.' �`
Tdal land (line 1 plus line 2) (3)
Dwelling (4) =t�Y aiarf ���"`"x����:
Residential imprwemenis �
: }=.--t i.t�� h3 ��_ � �� -
Garage �5) ; r 's,% �. ;o,.
... r,. .�n-�.x.:,._..��,.�.{� .
., , _ -
Other improvements (6) -. {� ;�;�,; _� `- M
Taai impmvemenls (line 4 through line 6) (7)
TUaI value (line 3 phs line � (g)
1 hereby certify the above is lrue, conecf, and Signamre otASSessor oate signed
complete.
Verih�ing action - Signature of Putlitor Date signed
?-.�''��.0 f .�,-�i ?.df'3"�::e�7�'�'.-h � :.'s•:i." t��A.`.�~SSTANUARD'DEUUCTION'A�LOWANCE �,i,'.is.��'a...a...,�.� _'"' T�. �r`� y � .-. � ,��
20 _ Pay 20 _
Lesser of 1f2 Homestead
ValuaGon or $6,000
S
S atu mtAu or Datesignetl
ao ro�