HomeMy WebLinkAboutHomestead_BesteCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hcto
State I= 5473 (R614-03)
prescribed by the Department of Local Government Finanoe
INSTRUCTIONS: See reverse side for riling instructions.
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ER FICA ON STA NIENT -----
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I (We) 1 W24.&"Ju�6.4 VN -V-tz-� A pzx�L' carat Mni tjPyofNjhrch,,P0_
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I (We) oockpfid as our principal place of residence the following described real property for which a Homest Pro r here y claimed:
lWF1 I (We) owned ❑ Are buying under contract MAY 10 2005
ave a beneficial interest in the entity that is liable for the property taxes an the property and that owns the property or is buying under a contract.
If buying on contract, F" Simple owner's name
Recorder's office where contract
Record number 1Page
4 � -.-��� "PROPERT,Y-DESCRIPtION'i7f'- _. --
County
Township
Township
Taxing district (city, town, township)
Signature of claimant
dg-ription
Signature of Auditor
M aA,01,L B
Is the property in question:
?71r-�00114-00
I f" / I 9�9t
Xk&
7 ❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residmdal structure or the land not exotredinh we (1) acla
that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPEkT.Y–�OWNED!fBY,,CLAJMkNTIN'OTHER'. COUNTIESt�
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
We (number and street, dy, state, ZIP code)
g-g I A
TRLIE,,TW�'
�,Cliiiiiii6'gk'Gifl:��,HOMESTEAD;g
Lesser of 1/2 Homestead
'.-'��'�NONLRESIDENTtALI.*,�',SI
P-1
S
Signature of Auditor
M aA,01,L B
Dart si d
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Land not exceeding 1 (one) acne immediately
surrounding residential Improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
N
improvements
(6)
4
,qjgmr
Trial improvements (line 4 through line 6)
(7)
Total value (fine 3 pits line 7)
(8)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
` STANDARDrDEDUCTION'ALLOWANCE.-
20 Pay 20
Lesser of 1/2 Homestead
Valuation or MOOD
S
Signature of Auditor
M aA,01,L B
Dart si d
r- /c - Ins-
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