HomeMy WebLinkAboutHomestead_PaytonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Forin 5473 (R4 I B-00)
INSTRUCTIONS., See reverse side for filing instructions.
FORM YEAR
HC10
1 (we) CK 14 - 717-4 410 - r - i - following - -)A - .4 Z—V certify that on the 1st day of March, 20_
1 (We) occupied as our principal place of reside�ncel !rfol!ZescribedTal property a Homestead Property Tax Credit is hereby claimed:
i(We) owned El Are buying under contract
ave a beneficial interest in the entity that is liable for the prop" taxes on the property and that owns the property or is buying under a contract.
If buying on contract. Fee Simple owners name
Recorders office where ="of is recorded Record number Page
EgVfD Sdlk1Pffl0
County
Township Taxing district (city to". township)
Parcel number
Legal description
ss (number and street city; state, ZIP code)
3&
It any portion of the residential structure or the Land not exceeding we (1) am that immediately surrounds that structure is used to produce income, describe the use and portion
of the Property utilized to produce income.
F QWNED -1 T RIC W NIR ie"
Eff PERT�Y'
ME
County Township
Cou Township
I hereby oertfy the above statements are true, correct and complete.
nature of claimant
ss (number and street city; state, ZIP code)
M-1 M-111FA
..ISS
11MUSSMORMS 170�' MINIM
T UE-TU
'7
W9SE9gEDj
VAZLI
'S 0
-A 1070
D
A—RNUrE"C1REiW5AVJ ..
0 W I
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
AWR nw.
06
Garage
(5)
N:
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
complete.
Sigpalureofftsessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000
N