HomeMy WebLinkAboutHomestead_BarriballCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R61403)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) IY that on the t1t11s�tt day of March, 20
(We) occupied as our principal place of residence the following de bed real property for which a Homeste_ a Property NUedit is hereby daimed:
❑ I (We) owned ❑ Are buying under contract 80k &,414 / �/ /�
Ef Have a beneficial interest in the entity that is liable for the property taxes on the pr and that owns the property�s buyirg.under a contract.
s= '`iaeCONTRACT.'REC_OR_DED't- "".{lam
�f tin:
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded .Record number Page
Lr�:_
-
County
Township
Testing district (tiry, town, township)
Parcel rum r ^
_Cb
Legal descd do Ue property in question:
_ // 7
Real property ❑ Mobile Homo ( /.C. 6-1.1 -7)
H any potion of the residential structure or the land not exceeding one (1) acre that immediate at structure is used to produce income, describe the use and portion
of the property uuli, to produce income.
'_`•' a• �€ ����Y�},><„-`' �' �• N: ��*, ��PROP .ERTY,OWNED`BY�'CLAIMIANT_IN' OTHER' COUNTIES} r�' �' dN�� +,�=- `.:��- "�,..��?'"=."��a9 �'-?
County
Township
County Township
hereby certify the above statements are We, correct and complete.
Signat of claiman
c VALUE`'
A d s (number and street, city, state, ZIP ce)
`'ASSESSDR`USE
TRUE_ AX
ASSESSED VALUE
'�aHOMESTEAD
j NON;RESfDEHTIAL
.,:,+ -xp; 04'; ,yr�''S
INNER`
c VALUE`'
ATz100 %iOP,TN
y 6VALUE
-z�. VALUES i
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(t)
`Sb',;K,,'�".d -•>'' t -e.a''
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)-
�v -,col
#,'cP
Residential Improvements or Annually
Assessed Motile / Manufactured Home
Garage
(6).hb''•,
K�'
Other improvements
(6)1
ar
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Vedfying action - Signature of Auditor
Date signed
•^: E'Opi , ++`'M-'A�- „�AO MSTANDARD.DEDUCTIONiALLOWANCE,
20 _ Pay 20
Lesser of 112 Homestead
vauauon or 535.000
$
Signature o Date sill
-btu