HomeMy WebLinkAboutHomestead_BysarovichCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions,
" F-I 7 --Lr -
I (We) centifyithatlon the 1st Ir r 20
:. 'I It ❑ —
it P-roperty Tax Creiditig he
I (We) occupied as our principal place of residence the following describE(5 eal property for which a Homestead claimed:
17 March,
❑ I (We) owned ❑ Are buying under contract
AkHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property 06 2004
or is buying under a contract.
If buying on contract. Fes Simple owners name
Recorder's office where contract is recorded
Record number I Page
E T'y 6
��ihWIMMM-0MO R ESCR P I N� p
11 A, , � " t r;;
County
7oxnship
Taring district (city, 7
67MO VO-00
Legal
tu
im kid
e property in quTstion:
&2 VReal property ❑ Mobile Home C. 1.1 -7)
If any portion of the residential structure or the land not ex-eV,
of the property utilized to produce income.
we (1) acre that immediately surrounds that s ure is used to produce income, describe the use and portion
CLfAIMA9-T;IkfoTHEkt6"fit!i��� MZ_l U6
County
T00%mship
County
Township
I hereby certify the above statements are true, correct and complete.
Sign f daimant
Address (number and street, city, state, ZIP code)
AWQZ-) Sislailk-'/rA ��L 0adard. L' )LJAJ d_76 1_/1
I
4A'hS8E$SOR USE
.—TRUE-TAX��'y4:_
VALUE
qq% OF—Tm
r�HOIII!l
awty��UE
Q 4i EhifAt
j= r
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Otherland
(2 )
f" �..Y`
lg
Total land (line I plus line 2)
(3)
Dwelling
(4)
W
Residential Improvements or Annually
Assessed Mobile /Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
.evaluation or 535.000
S
M