HomeMy WebLinkAboutHomestead_Buck (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10 3
State Fonn 5473 (RS 110 -01)
uu Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instructions.
CERTIFICATION STATEMENT =..
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1 (We) I certify th eri th 1s ay of ar 0
I (We) occupied as our principal pl of residence the following described real property for which a Homestead Pr I Is hereby claimed:
❑ ](We) owned ❑ Are buying under contract 1 AN 2 g 2002
jHave 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 . A
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded
Record number I Page
��' -.-... � -.t:s,e .', 3.:: . , RROP,ERTY.DESCRIPTION- r. - -
County
as
Taxing district (dt nhip)
I hereby certify the above statements are true, correct and complete.
Sig
-
P ce mbar ;;
Legal description , ,
r t u';1 ::.-
Is the property in question:
',I r: ,❑ Real property ❑ Mobile Homo (I.C. bf.1 -7)
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If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
VALE ' s
Ob 3 - 00 U-7 -00
HOMESTEAD'�U
—2.r-'54o - �. a
.k„
_ .;,'`r? " {'ti`r -✓ 'r_. is,. �,.7=`_??,",PROPERTY,OWNED BY CLAIMANT IN OTH EWCOUNTIESi�. ;'.. -. ±a Sr i.-? .. �.='•'f`" '::?
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Sig
re of claimant
Addr s (numppr and street, city, st e, ZIP cod
112 $
a If 74
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1i�'S 1IY�`y�' il��! •C- LT TS
§ASSESSOR USE ONLY
VALE ' s
E00
HOMESTEAD'�U
Y .A
R,NO - RESIDENTIAL
.k„
�43T
y. r"t, y
AT. %a OFTTV
.....:... a
?� aTS''VALUE.ro (..cT.t
r .�"VALUEn
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
L e ;
"s �5,'- � �
Dwelling
(4)
�i >�r' r +tfY``3:
Residential improvements
Garage
( )
Other improvements
(6)
:zf .
Total improvements (line 4 through line 6)
(7)
value (line 3 plus line 7)
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
_ , �g3,.,•r-'.AS`a. •n?,a+� ' TANDARD:OEDUCTION'ALCOWANCE
'l, ,,';;
® 20 Pay 20 _
Lesse H estead
112 $
alu lion 6,000
Signature of Auditor
Dal igned
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