HomeMy WebLinkAboutHomestead_WiseCLAIM FOR HOMESTEAD PROPERTY TAX FORM Y�R
- " CREDIT/STANDARD DEDUCTION HCto
� . � Slale Form 5473 (RS / 70-01)
••y Prescribed by Ihe Department of Local Govemment Finance
INSTRUCTIONS: See reverse side Ior (ling instructions. -�j "' --
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���' "�`'�"'�•x"` .. a"s'�' �"�,i;±3�'�4"`CERTIFICA710N TAIEMENTi�,t�''7'-"N. )
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� (We) certiry Ihat on thef�jp`��a�f3ui�i��0—
I(We) oECUpied as our principal place of residence the (ollowing described re roperty for which a Homestead Prop/er�ty Tac Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under contract y(���
� Have a benefidal interest in fhe entiry Nal is liable (or ihe property taxes on the property and that owns lha pmper'ry or is buyin under a contrac[�
LiICS�p: . �liviivn
If buyiri9 on conVad, Fee Simple owners name
Recordefs ofice where mntrad is recorded
Counry
l`��.� VJ)
H any poAion at Ne resiE
ot the property utP¢eE tu
COUnty
Tamship
aW ch�re w Ne
ce inoome.
TwvnShip
ona (1 � arte thet
I hereby certify ihe above statemenLs are We, corred and complete.
Counry
Remrd number � Page
fown,
Is Ihe property in quesUon:
❑ Real property ❑ Mobile Homo (I.C. 61.
Ihat sW cNre L5 used b produte income, desfrihe Ne use and portion
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c s�>ASSESSO� R%�U ON Y� '�-' -�UETAX���,+� ;ASSESSED�VALUE �'+HOMESTFIJ q NON=RES�OENTIAL�
���.o��r�r4ay�����y��� �w.VALUE� �r ATt100%�:OFIuY - .=?�VALUE+�� �u���,F,{�f"`���}'�VALUE�
� -,� �, w„ ' : ,.....� ,.
Land not exceeding 1(one) aue immediatey ��w'.*��`�"� i,_ ��i�
1 �� �a�a
surrounding residendal improvements. ( � �,� �a;�v�-.�,�,,,�^T�+-' f;: . _ . ���
t���- r� �� .
Otherland (Z) �:w �""�
a� ��
TUaI land (line 1 plus line 2) (g)
���a���� t .
Dwellin9 i4) :�- 4+.' � £ �'� } i
Residen6al imprwements � `�"'a'3"' `�' ��" ���
�:;�;-r;:-'.-a-."�="°°"#: --,�`
Garage 5 o-?.'..K� ,.�e'��,.F - x
( ) c�s ;'�c... �+.'�,�x.R..'�'� . ...'y�<�
',"`'-�.�`-t: .'� t
Other improvemenls (6) � �'„. ;t';- �
f."?`:+: �.. .t�5:...
TUaI improvements (line 4 through line 6) (7�
Tatal value (line 3 plus line n (g�
I hereby certify Ute above is We, torted, and Signature ofASSessor Date signed
complela.
Verih�ing acGOn - Signature of Auditor Date signed
20_Pay20_
Lesser o( 72 Homestead
Valuation or $6.000
$ignalure Of Audilw j�1�in �A \���JI (� �� I va�� s�y.�ey� � A� I
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