HomeMy WebLinkAboutHomestead_NealCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HCto
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
(We) -a 11 f '1 ', !f d
certify that on the 1st dey of March?20_
(We) occupied as our prin Ipal place of residence the following described real property for which a Homestead PropertyJULCredit is /pq�r�g¢y claimed:
❑ I (We) owned Are buying under contract 1 b NA
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property, or is buginglgn ter a contract~
If buying on contract, Fee Simple owners name
where contract is recorded
Record number I Page
A f.-�4 r.�' r'v^."- ., -".4.2 .,.r3P.ROPERTY.DESCRIPTION'e _.'z".."t � ",a's'g,` .:Fa ,t��Y+,+s sr, r` ^`s".sa` .fora{. —?
County
Tomship
Taring district
Par mypbc7
U`'/(
L al cdp^
Is the pro in question_
-v0
Addre ss ( ber and sueel, city, state, ZIP code)
eel Droperry ❑ Mobile Homo (LC. 6-1.1-7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediaty wnounds that structure is used t produce income, describe the use and portion
of the property utilized to produce income.
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ASSESSOR -USE ONLY
%s-- 'xT.;Xa�f°'8= - P,ROPERTY.OWNEUTBI' CLAIMANT' IN .rOTHER'COUNTIES+x'fw_ ^siP -l'�n f3�
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Si nature of ant
Addre ss ( ber and sueel, city, state, ZIP code)
2 $ 27y O� Ic �.V .
b
Sign o dilor
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ASSESSOR -USE ONLY
,r"T" TRUETAX� r
ASSESSED VALUE
HOMESTEAD'
_E
``Z: - -
NONIREWDENTIAL�
;zz• e ?i;r a._;atY°.r,�,q;
VA_I.UEy,s�ti
':`:4Tx100Ye OF�TTVr
VALUE'-
�u VALUE- s�.r,'F'`�„
Land not exceeding 1 (one) acre immediately
-tk
surrounding residential improvements.
�
Otherland
Afii`'sr
(2)
v
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
='° rE�"
or Annually`'x.1a'�'
Assessed Mobile I Manufactured Horne
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 2)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor _
Date signed
- §Y Vic; &-g-- `:� ,ris'S�i_ STANDARD.DEDUCTION'ALLOWANCE
20 _ Pay 20 _
Lesser of 112 Homestead
value or 535.000
$
Sign o dilor
Dat 3igpgd / _ O