HomeMy WebLinkAboutHomestead_BlakeCLAIM FOR HOMESTEAD PR OPERTYT AX
FORM
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 IRS 14-03) Y�
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. FILEI-Y
I (We) A 1UZI - tXj 4 NjgA�&A P certify that on the tat day of-March, 20_
1 (We) occupied as our principal place of residence the following described real property for which a Homestead ProW Tax Is hereby claimed:
71 1 (We) owned -'�' esnp-?
❑ Are buying under contract Or .AUDITOR
0
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns fh�R��qpjNZY
a buying under a contract.
ONTRACT.,RECORDEDtit;;�-4r-,LN7�-�l��_4
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
R7 NTI
COU ES
PF�-OP�ERTY�.DES�CRIP.TION-�,V,',I
Township C
County T
rti
Ll��
County
1161310�'-
Township
I Taxing district (oily, town t��Cdu
(rumiler and
02W �15-
Parcel number 8 /_C)b
D1&1- CO3
Legal pin
&b
roperty In question:
QgrA4 I
�Bda
�P Real property ❑ Mobile Home
If any portion of the residential stricture or the land not exceeding we (1) am that fmadiately
surrounds that sfrucbjm is used to produce income, describe the use and portion
of the property utilized to produce Income.
R7 NTI
COU ES
County T
Township C
County T
Townships
I
I hereby certify the above statements are true, correct and complete. =
=n,
(rumiler and
02W �15-
ASSESSOR USE�ONLY 4TIR U E TAX - "
ASSESSEDNALUE
I 71�4ft ffi-AT�100%017TTW VX U E 1
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements. V- V-
Otherland
(2)
Total land (line I plus line 2) (3)
Dwelling (4)
n,
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
Vber improvements (6)
Total Improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true, correct, and Signature of Assessor Date signed
complete.
Verityarg action - Signature of Auditor I Date signed
STANDARD, DEDUCTION ALLOWANCE. . .....
20_Pay2O_
Lesser of 1/2 Homestead
Valuation or $35,000 $
--A U
STANDARD, DEDUCTION ALLOWANCE. . .....
20_Pay2O_
Lesser of 1/2 Homestead
Valuation or $35,000 $
--A U