HomeMy WebLinkAboutHomestead_Besing1s'
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R61403)
Proscribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) J certify that on the 1st day of March, 20
(We) occupied as our principal place of residence the following described real property which a Homestead Prg1 Wjty' Tax Cn &D41hereby 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 lte p
the buy unde ? a con ntract.
ONTRACT.'RECORDEDr" ssys.'-'. F�".-, a' 'try'•__,`,fs'°- :'z%,,,'�"r -*,�
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
e PROVE RTY;OWNEEIBYCLAIMANit, IN!OTRER`COUNTIES � >� �,,�8 �'a 'fie �,•a"g'
PROPERTY 1i ESCRIPTIONR??,. 3` .�✓i?'`.,R.,FS`"`?'u�%i,'"";Ys?
County
Township
I hereby certify the above statements are true, correct and complete.
Testing district (city, to". township)
P/a el nu ber
V
al
do
Is the property' uesfion:
Seal property ❑ Mobile Home (I.C. 6-1.1 -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, describe the use and portion
of the property utilized to produce income. ?� `G) �f
e PROVE RTY;OWNEEIBYCLAIMANit, IN!OTRER`COUNTIES � >� �,,�8 �'a 'fie �,•a"g'
County
Township
County - To mship
I hereby certify the above statements are true, correct and complete.
Signature of claimant_
JV I!V(
Address (number and street, city, state, ZIP code)
�'ASSESSORUSE ONLY-'��
. >-,- 5; -=ha„ <
TRUETP`'
�•.VALI r. °-c100 ° %_.OF.TTVVALUE.t
HOMESTEAD�z
NON == RESIDENTIAL
``VALUE ' in-
Land not exceeding 1 (one) acre immediately
c� MORRIS °q
surrounding residential improvements.
t".;
Other land
Of
(4)
Total land (line 1 plus line 2)
Dwelling
y,.�,>•dr``' -4
t'
RROM
esidential improvements or Annually
� .
1714-+ r' but
Assessed Mobile I Manufactured Nora
e Gara
0
(5)
(6)
v .
Other improvements
;"t_..
'}R.?r
�k'r
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
Signature of Auditor
20 _ Pay 20
Lesser of 112 Homestead
Valuation or $35.000
r
771
Dale signed