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y 1 CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
? '� CREDIT/STANDARD DEDUCTION HC10
�.. State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
a k.rt 1= "..t,;(nt;'--;-1114_ . ?-,z:`CER a ATION STATEMENT= s3"n- y t*e-iW 1.-K. .
I(We) �•�� -o- ,-..- - , ' a.. 15 ..4AC w'+ I t � .
- ty • -e 1st day of March,20
I(We)occupied as our principal place's residence the following described real property for which a Homestead Prope#TT CredilOj5ereby claimed:
❑ I(We)owned ❑ Are buying under contract L
0 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pro g,qr is bu*Vhder a contract.
GIB OW C fUN✓,.-TY AMBIT-QM
�;< °:4„,-,- az v it tVAgz".•4 V i£4CONTRACT_RECORDED_tit y +?SlScTr s1Td i ' 4
p2 ms
ce?STI
If buying on contrail.Fee Simple owners name
Recorders office where contract is recorded Record number Page
%MSSA£ -°r+vSi i: air's_ -III ROP,ERT,Y:D ESCRIPTIONIST- „' 2":`;3.!e , irraW'. ¢ .e},earia ?t``n'}»
County Township Taxing district(city,town,township)
Pa nu/)�mber I � ( ) Tr/1u Is the property in question:
' _ O I O `--`� 9-�.-8 �l�I�e,_ ❑ Real property ❑ Mobile Homo(LC.61.1-7)
I any portion of the residential structure or the 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.
%;'-Ls`:V Sactrilat���a�:.�- t-f$ `P,ROPERTYOWNED`BY CLAIMA :IN_OTHER'000NTIE5.05 AKR z �* �` '°`�'� "a r
County Township Co ty Township
I hereby certify the above statements are true,correct and complete. enatur- •Or laimant
i
Address(number ands•• et,city,state,ZIP code)
0111_0_ _Via,.
'F" rc - lt,fi -a3.",-Lty'Y.r �-- #� aw -TRUETAX, F ASSESSED VALUE , HOMESTEADS' ' NON RESIDENTIAL=
A- ASSESSOR USE ONLY
x{:`3'.'�fSv"�`?';?l�-w u'*n;:P` � .te a °."> ...3 �vALUEit- a. .a:rivreOF TTVa3 tax, vAymaa. amt -214. >a
Land not exceeding 1 (one)acre immediately 1 T' .xt3,+3 .15 i•. '
surrounding residential improvements. () y - sw
Other land f." rtr`r'F,..,,:.gig=
Total land(line 1 plus line 2) (3)
Ti taraCtf
Dwelling (4) v 6,4t t._ „ .r
�_ c
(Residential improvements or Annually i _ - �
Assessed Mobile/Manufactured Home Garage (5) get . st° „+-P•-1 ,
a ;K �.,_.
;l Fa--
k,., =wit _S:±
Other improvements (6) = ".;-
ice.,.
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 Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor
Date signed
anEW.,La.3=: -i}6i. 1*nu'�ati`ai. r 4fl STANDARD_DEDUCTION ALLOWANCE :!.°`^. `izi ,.ytl :par- sb`T:rt a�¢` mitt,
20 Pay 20_
Lesser of 1/2 Homestead
Valuation or S35.000
$
Signature or Auditor Muu"
Date si ned
-�' — g
ll File Edit View 6pplications Tools Window Help
co 4- > - �}' �' l ®i : '� M 4 b . zoos a�Y 2oi o
Real typ a IReal J Property 126-14-19-102-001.383-006 - - - �'
_
PldentiUcation ®Addresst aluations �! Taxes Transfers r ®Specials �[7N otes Adjustments 1, Lender I
VUIICIII /1JSCD JIIICIIIS- - - -- - -.
Current Deductions,;
ry {; Home steed Approved "
171 Over 65 C.B.
.Override Flag I Improve
] No _
1 No
)es
_II � New
�gemove L
will, I j�Qodi(y
Homestead 60D0
Res, LTC, Ag
Non Residential
Total Assessed 6000
NetAssessed 1560
r jj'UnderAppeal
(I AV Deteils
District -Base AV Base Res AV Incremental AV
,
�i .� li� —II rf TIF Override
J
Parcel Last Up
Thursday,
3/16/2009 2:41:00 PM by smounts
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Type
Actual Value
Eli ible Value
1
New
Homestead Land
_ 6000
_6.000
Homestead Improv
6
0
Residential Land
0
0
��
l$emove
Residential Improv
0 0 i
Agricultural Land
Long Term Care Lend
Lon g Term Cerelm p rov
_
— D 0.;
D 0
0 0
Moddy
Nonresidential Land
0 ! 0
Nonresidential Improv
0 i 0
"
Current Deductions,;
ry {; Home steed Approved "
171 Over 65 C.B.
.Override Flag I Improve
] No _
1 No
)es
_II � New
�gemove L
will, I j�Qodi(y
Homestead 60D0
Res, LTC, Ag
Non Residential
Total Assessed 6000
NetAssessed 1560
r jj'UnderAppeal
(I AV Deteils
District -Base AV Base Res AV Incremental AV
,
�i .� li� —II rf TIF Override
J
Parcel Last Up
Thursday,
3/16/2009 2:41:00 PM by smounts
F
t:7;
Ci rt,
1
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1
1
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