HomeMy WebLinkAboutHomestead_Arendell (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10 M
u J State Form 5473 (R5 110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instructions.
I (VJe) /f/ IV 0( / l/t/ c- �/y�./��( certify th th st ay of �ar�rc ,
I (We) occupied as our principal place of residence the following described real property for which a Homestead Prt T C dit is re y im
❑ 1 (We) owned El Are buying under contract M� y
ibiave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property o} I�Huying InAg2ontract.
If buying on contract, Fee Simple owner's name
where contract is recorded
Y4
Record number I Page
ysYxs -.,s.
P,ROP,ERT.Y DESCRIP.TI60-7�;3? ,:4s.
Cau h
Township
Taring district (city, town, township)
Pgr4el number
U (0--0001q-co
Ides ' do O /'1 „ ,,,
rlCy ,P4J`�/
Is the pro in question:
Real property ❑ Mobile Home (LC. fr f.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that suucture is used to produce income, describe the use and portion
of the property utilized to produce income.
y"'"��•`p'"���"���'>�x�,��.', P.ROP,ERTY,OVIINED`BY' CLAIMANT, IN'OTHER`COUNTIES?�'..�Jty�3.y' ji�' i..' �" 3�s� .3- �- irt� "- .'k-- z�.'r_`.�?'i
County Township
County Township
hereby certify the above statements are We, correct and complete.
re of c
a
iadr. (number and street, dry; state, ZlP code)
2z3 lt/. M n K /cn / rti q 76So
y >r s
�' ASSESSOR'USE ONLY
�`�',
e
TRUE TAX
S'' '..
ASSESSED.VALUE
%:OFATTV�
�_
?wHOMESTEAD
tVALUEFA
�;..
s NON = RESIDENTIAL'' t+
r
%. ,
S4VA_LUE -
yAT�100
VALUE ,`r�
Land not exceeding 1 one acre immediately
"r••' �"nr < x k
surrounding residential improvements.
om.
.�
Other land
(2)
..rte• -�t,• �L��
f?� -��•
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
_h
5. 'r ,
1.44io �a..l.3
Residential improvements
Garage
(5)
OMAN, G. ? •9 .;t'
Other improvements
(6)
•fiao' ; _ :X =,
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus linen
(g)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000
ffow