HomeMy WebLinkAboutHomestead_Witt4� ?�� � CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
t=� J State Fwm 5473 (RS / 10-01)
�°� Prescribed by the Depanment of Local Govemmem Finance
INSTRUCTIONS: See reverse side (or li/ing insWCtions.
FORM YEAR
HC10 „R
���\,
I(We) \ _� � . certify that on the 1st day of March, 20
I(We) occupied s ur pr ci place of residence the following descnbed real property (or which a Homestead Property T�c Credit is hereby daimed:
❑ I(VJe) owne Are buying under coniract
�Have a benefidai interest in the entity that is liable for �he property laxes on the pwperty and that owns the property or is buying under a conUact.
. . _ _
c.�_sr�'e ',�...,�- "' .� --t � , <�. . •'CONTRACT::RECORDED....a '.. _:<..;� .r_..,. .s .
c � �. �„3;• ,"��' - a . 1 ;� x - ..ri._,,,_� _
If buying on contract, Fee Simple owners namea
RemNefs oifice where wntracl is recorde0 Rewrd number Page
Counry
Tamship
I `i' l:J Jot7V"GV
portion of tne resitlential sWCwre w Ne land not
property utilized in produce income.
Tacing tlislrict (uty, fown, township)
I r�perry in ques "
.. ./b I pmperty � blabile Homa (I.C. 67.1-7)
aae Ih mmediatety sunounds �hat swaure is used to D�oduce f�come. describe the use antl ponion
' Y - � s � � �-' � ` '"� - ' TRUETAX � ASSESSED VALUE HOMESTEAD � �� NON RESIDENTIAL .<S
3f _���,�., ASSESSOR USE ONLY `{ -j :z 1 yqLUE- AT 100%OFl7V -'. VALUE s.-.��' �� � � � ,: VALUE'. .� �" -�.'
:�.tr. :�._ t.��:r�"��, �1� 'a�., . i . -i.:N r9 �:
Land nol exceeding 1(one) acre immediately -�; �� '" s-
surroundingresidenfiaiimprovemenGs. (�) �- ._,?,`--<. �� .� =�
Otherland (p) ` � 's.
Tdal land (line 7 plus line 2) (g�
�' t�<, .
Dwelling (4) .-�,�, y .;� } . ��,7 i� ':
Residential improvemenLS - �
y s m �' �
Garage (5) �.t� r �i�`.`�s`�'r"'�.kcYY si_.
� k. ...,. �,�3�_ � .t
Other improvements (6) Y _
_ :,g t
TUaI improvemenLS (line 4 through line 6) (7�
Tdal value (lina 3 plis line n (g�
1 hereby certi(y Ihe above is We, covecl, and Signamre ofASSeswr Date signed
complete.
Verifying action - Signature ofAutlitor Date signe0
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or 56.000
SgnaWre oflwditor
S
° ± Date