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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R715�W)
Prescribed by the Departinard cd Lo ®1 Goverrynart Fr MAY 1 5 200
INSTRUCTIONS: Sao reverse side tar ming instructions.
I (We) V (_ ( y Ut. - certify that on the 1 at day of March, 20_
1 (We) occupied as our principal place of residence the following described real property for which a Homestead! Property Tax Creclit is hereby dairned:
kLi I (We) owned ❑ Are buying under contract
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 under a contract
CONTRACT. RC-CORDM
tf hrflV an ..b Fee Simple owners name
Pwccnleei; office _hero antmd is reaxdad Peoord number Page
I V
PROPEM MNED BY, CLAMIANTIN OTHER COUNIIEV,
PROPERTYDESCRIPM(M�.:
County
TaNnship
T—V . fal"now)
Parcel amber
Legal description
'AT
Is the property in question:
I [] ❑
$
vo
Real Wripixty Modl. fora (I.C. 61.1 -7)
ff any portion of the resklenbal struchwe or the IwW ncVexceadng are (1) acre to irnmedialdy surrounds tital structure is used to pnxkm incorne, desarbe the use and potion
of the property Wind to prodtice incurne-
Lad not exceeding 1 (one) acre iffirriecliately
0
I V
PROPEM MNED BY, CLAMIANTIN OTHER COUNIIEV,
County
Township
County
Township
I hereby certify the above staterrients are true, correct and corriplets-
sigrusture of daffnard
'AT
urriber and Street city.
9A c( / LCL
$
STANDMW GMUCTIM
TRUE TAX.
'ALili
'71,"H"O'SIESTEAD'
-NON
Lesser of 12 Homestead
MAW
'AT
$
Valuation or $35,000
swishire of &mawr
Lad not exceeding 1 (one) acre iffirriecliately
0
'9
OKA
surrounding residential improvements.
Other land
(2)
Tdaf land (line I plus &w 2)
(3)
Delng
wli
(4)
1,
Residential Residential err Annually
Em
Garage
J�l < 11ir
Assessed Manufactured Harris
•
(5)
Other improvernerits
(6)
Tctad wriproverneffts; (rme 4 through fine 6)
(7)
Tdal value (Arre 3 phs Ene 7)
(8)
I hereby certify the above is true, coirrect, and
conlPleta.
SW%ah" of Assesoxx
Date signed
Vertlying ac dm -.%Qrmtffe of AucfibN
Mile signed
STANDMW GMUCTIM
20_ Pay 2O_
Lesser of 12 Homestead
$
Valuation or $35,000
swishire of &mawr
Date sVmd