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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing insirm.,nons,
YEAR
...... CERTIFICATtOPI, STATEMENT.-.\
I (We) rtify that an the 1st day of March. 20
I (We) ocxcupie a our prinq place of residence the following described real property for which a ead Property Tax Credit is hereby claimed:
oc
I (We)
e buying under contract
M Have 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.
I t'rJi�
CONTRACT RECORDED"
If buying on contract. Fee Simple "net's name X -L.J JL-j A-09
Recorder's office where contract is recorded rhTQRd@.8bR05 I Page
OPERTY OWNED OTHER
BY CLAIMANT 114 Fb 0- U NTIES-
PROPERTY DESCRIPTION
County
Township
I Township
TaMg district (city, to". town"SON CO - UNTY AUDITOR
P r
T _G
I ga
lion
V-4
I hereby certify the above statements are true, correct and complete.
Is the property in question:
ro
ddrass (number and street, city, state. ZIP code) 0
YZ R
'n
Mi -ASSESSOR USE ONLY
TRUE TAX
VALUE
property El Mobile Home (I.C. 61.1-7)
If any portion of the residential structure or the land not exceeding one (1)
acre that immedlea5cmis that structure is used to produce income. describe the use and Portion
of the property utilized to produce income.
ce - /j - /"? - 3 'Vo
OPERTY OWNED OTHER
BY CLAIMANT 114 Fb 0- U NTIES-
County
County
I Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
O
ddrass (number and street, city, state. ZIP code) 0
YZ R
'n
Mi -ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED VALUE
AT1006/60F.TTV-
'HOMESTEAD
VALUE
NON-RESIDENTIAL,
% -- VALUE: -.
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Otherland
(2)
TcW land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manufactured Harris
Dwelling
Garage
(4)
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
STANDARD. DEDUCTION ALLOWANCE..
20 _ Pay 20_
Lesser of 112 Homestead
vaitiation or 435.000
Signature of Auditor Vz /a /75'
3