HomeMy WebLinkAboutHomestead_Hume (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION
Stale Form 5473 (R6 /4-03)
.prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing insituclintis.
ON STATEMENT,%,
�CERTIFICA
I (We) rAPRh2 c5 IUIA day of March, 20
I (We) occupied as our principal place f eunce the folOving described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ 1 (We) owned ❑ Are buying under contract
RHave a beneficial interest in the entity that is liable for the property taxes on the property and that c tgr WftyligNitcler a contract.
Gl6%'6U'6
ts: �.-Ii-�tcolITRACTRECORDEDz-lo-:,f,e
If buying on contract. Fed Simple �—Eetnmaf
I
Recorders office wher = is recorded Record number Page
County Tmnship Taxing district (city, to", township)
:p Legal description Is the property in question:
nM�Wq03tT I ❑ Real properly ❑ M.1bito HMO (I.C. 6.1.1-7)
If any portion of the residential structure, or the land not exceeding one (1) aue hat immediately surrounds that structure is used to produce Income, describe the use and portion
income. e
of the property utilized to produce in ;/
County
Township
I hereby certify the above statements are true, correct and complete.
iumber and street, city, stale,
q / 7 C.) I n 5
Township
ONLY;�.t Vz
TRLIE-TAX�,,
ASSESSED V�Gi
okiftia 6"F!
-EWVAL
��Xf NON-RESIDENTIAL.
---.ASSESSOR'USE
" W:,, — _k ; � -
-n;a�--
VAL U E
!AT,100%T6F;T1VA
Land not exceeding I (one) acre immediately
surrounding residential improvements-
Other land
(2)
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
.
Assessed Mobile I Manufactured Home
Garage
(5)
A
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, oorreci. and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
low ;,eY4'-�."-ISTANDARD.DEDUCTION:ALLOWANCES�- -,�.;i,-, "�..,-.,,1�-,-;OA,�-
20 _ Pay 20_
Lesser of 112 Homestead
Vaivation or E35.000
Signature of Auditor Dateqned