Homestead_AtkinsCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
` ✓ Slate Form 5473 (R817 -07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
F YEAR
HC10 .
I (We) certify that on the 1 st day of March, 20_
1 (We) occupied as our principal place of residence the f wing described real property for which a Homestead that
Tax Credit is hereby claimed:
I (We) owned U Are buying under contract
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.
CONTRACT •-r
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
County
I hereby certify the above statements are true, correct and complete.
tress (number and street city state.
County
ASSESSOR USE ONLY
TRUE TAX VALUE
ASS_ESS*1ED VALUE
PROPERTY DESCRIPTION
Counly
Township Tmciryq di (city, town, township)
Parcel number
L al descdptlon /Utl Is the property in question
E L G iCj YC 1 ❑ Real pro ❑ Mobile Home (/C 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, descnbe the use and portion
of t;% property utilized to produce income.
o24v- /Y- /8- 30ct -000. oaY - do%
County
I hereby certify the above statements are true, correct and complete.
tress (number and street city state.
County
ASSESSOR USE ONLY
TRUE TAX VALUE
ASS_ESS*1ED VALUE
NON-RESIDENTIAL
AT 100% OF TTV
I
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
-
S
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pis line 7)
(8)
I hereby certify the above is true. correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day, year)
20_pay 20_
Lesser of 12
Homestead Valuation
or
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012 $
43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor n -J _ - I Date signed (month, day, year)