HomeMy WebLinkAboutHomestead_Bettagrt CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance _.�, if, >• �1
INSTRUCTIONS: See reverse side for filing inslnrcfions. kj
I (we) certify that on the 1st day of March, 20
�I (We occupied as our principal place of residence the following d bed real property for which a Homestead�Property Tax Credits hereby : a ed
(VJe) owned ❑ Are buying under contract v1350N C�JM1TY AUDITOR
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. °RECORDEDpz..''i
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
k° : •_:. i-'.� fr�h' .`i w�- 6P,ERT,Y15ESCRIPTION
County
Township
I
Testing district (rjp! own, I fp)
Parcel number
Legal d sc'plion
�ATz100 %'OF�TiV
Is the propen q stion:
6 / 10 — o) — Q?
Land not exceeding 1 (one) acre immediately
eat Droperty ❑ Moble Home (I.C. 6-1.1 -7)
H any portion of the residenflal structure or the land not exceeding one (1) acre tha '
mediatey surrounds that structure is used to produce income, describe the use and portion
Of the property utilized to produce income.
' s�' ���y% �2s'` t> �?�'" �P, ROP, ERTY, OYJNEDBYCLAIMANT ;INOTHER`COIINTIESSs"', 3, �':. `-`�w- "�'��;;'�,�e}5''r�:��"�•i
County
Township
County nship
I hereby certify the above statements are true, correct and complete.
igna ant
dress (number and street, city, state, ZIP code)
�1i ,may s77°'" x
-�,
ASSESSOR'USEONLY . u-' T='
`''
'? -
TRUE TAX 3g5j1,
�uVALUE
_ ..
ASSESSED VALUE
- --v
'riHOMESTEAD
.. �...� Q
NON RESIDENTU_1L
-:
c;{
.��+g•,�`Rpo�•,35.f
•.w�'•��u,�-
�ATz100 %'OF�TiV
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
.
Other land
2.
O
f• es-
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
.,'''f -.a MOW-
Residential ial improvements or Annually"'^°
Assessed Mobile I Manufactured Home
Gara a
()
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 pits 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 .
sa YLn,— 1-ft `
;- D T
200yPa 200-5 1,)
Lesser of 1/2 Homestead
valuation or 535.000 .. t $
Signatur of ilor�� Date signed