HomeMy WebLinkAboutHomestead_Atkins (2)tin CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
S State Form 5473 (R4 / 8-00)
a.
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
I (We) 1 -V U,4' 4a V Q1* A Y Zn A:L -/LA k A.&I AAS. e rtify that on the tat day of March, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ 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, i. RECb RDED'ar`%k"��-.'2t_,`,.`
If buying on contract, Fee Simple owners name - -
Recorders office where contract is recorded - Record number - Page
_.-
'5,`-PROPERTjI'�D_ESCRIPTIONr"_
County
Township
Taxing district (city, town, township)
Parcel n bar
Legal description
'�A- s'T:'1UY^D wrN§
If any portion of the residential structure or the land not exceeding one (1) arse that im
of the property ublized to produce income.
mf* surrounds that structure is used to produce ince , describe thil use and portion
r/ "I
r. .",:.,,;— „;�•,ir,PRO_ P,ERI_l'1,OWNED�BY; CLAIM 7i_NTIN_,OTHER,COUN_TIES;,,-;�.
County Township
County -
Township
I hereby certify the above statements are true, correct and.complete.
Signature of
dress (number and street city state, LP code) vt
-"ASS SE3SO�R U�3EtONLY''v�= �
�TRUETAX
ABS,ESSED��VAIME.
v,V' STEAD
NON'RES ;DENTVa:L ..
1
�i+V -� Us.. E %' .
'�A- s'T:'1UY^D wrN§
&�' Vv?A� E
.L- '. Vs�.ALUFfa%.tt. _'
—„
Land not exceeding 1 (one) acre immediately '
(1)
r _
RR
surrounding residential improvements.
�4 . � ..:,.
Other land
r 01,".f.... sl
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'_.. �':••
Residential improvements
.1110' aEx
Garage
(5)
170 ..-
Other improvements
(6)
rC”
�+•�'--c�
Total improvements (line 4 through line 6)
(7)
I value (line 3 plus line 7)
(8)
1 hereby certify the above is We, conect, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Dale signed
DEDU6TION '••"'s��- "�"*�:-
3c�.•�3.a.. -"'ifs
20 _ Pay 20 _
Lesser of 12 Homestead
$
Valuation or $6,000
Signature of7uditor
Date signed