Homestead_AdamsCLAIM FOR HOMESTEAD PROPERTY FAX ..-
CREDIT /STANDARD DEDUCTION'
State Form 5473 (R6/4-03)
Prescribed by the Department of Loczilbovemmenl Finance
INSTRUCTIONS- See reverse side for filing inshuctinits
FORM YEAR
HC10
certify that on thWA I � March, 20
ccupied as our principal described real property for which a Homestead Property hNoclainned:
l(We)owned ❑ Are buying under contract
Wave a beneficial interest in the entity that is liable for the property taxes on the,property and that 'owns the property I contract.
kCT,.RECORDEDI�
.Al-i. If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
"P ROPERT.Y.DESCRIPTIO
Courtly
County
Tcrvnship
hereby certify the above statements are true, correct and co triplet
Taxing dist
dress (number and street, city, state, ZIP code)
tollm
I )�
tuber r
63
Legal d scri . Lion
-1
�
property in ct.isiJon
. Tn 'Real pnoWly
❑Mobile Horne (/.C. 6-1.1-7)
If X,y portion pf Ne residential structure or the land not exceeding one (1) a
of the property utilized to produce income.
lhat immediately surrounds that structure is used to produce income, describe the use and portion
-------- ------ ;PROPERTY EWCOUNTIES�Z�
O1NNE1j',BYC-LAlMANT�IN'OTH j �L,
Courtly
Twvnship
County Township
hereby certify the above statements are true, correct and co triplet
g
dress (number and street, city, state, ZIP code)
r
kIll, -
STAN DARD. D E D UCTI ON ALLOWANCE
20 _ Pay 20
Lesser of 112 Homestead
valuation or $35.000 $
Signature of Auditor
TRLIE-.TAX,�—,�',.
ASSESSEDYA.LUE
AY7 HOMESTEAD,-
1p -NONIRESIDENTIAL
ASSESSOR UWONLYJ'�-'— -`
,!' -
-�AT.,LICOWOF, V
I )�
4, I -��'VALLJE-lt,
�
Z—,�N —
Land not exceeding.1 (one) acre immediately
F i, =7' •"5r'
surrounding residential improvements.
-W
Other land
(2)
Total land (line 1 plus fine 2)
(3)
Dwelling
(4)
1, i
V
eT N50
WMW aD
Residenlial improvements or Annually
Assessed Mobile I Manturfachired Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 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
STAN DARD. D E D UCTI ON ALLOWANCE
20 _ Pay 20
Lesser of 112 Homestead
valuation or $35.000 $
Signature of Auditor