HomeMy WebLinkAboutHomestead_CampbellCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instnictrons.
y HC10 tj jI +7"\
AUG 16 2004
certify that grEthe I tsLday -of Marctv,�20_
(We) occupied as our principal pl of residence the to owing described real property for which a Homestead Property Tar Credit is herebyuialmed
❑ 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 the property or is buying under a contract.
-?3. �" jy CONTRACPRECORDED; `S sr"
s. -, e-,
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
__. _
PROPERTY:DESCRIP.T10N3� 4"i!' " ",
- e..7°'�s#'a".:.r'2'! k�
County
Township
.�.a -:+�: ..
�7HOMESTEAD'•.
Tadn i
trig (ity, ,towns
Parcel n ber
r
al d tiorc
p
.'E�.�RVALUE� s -.�*e.
Is the property i question:
�'�
_
Other land
(2)
Real property FAOblle Homo (I.C. 6f.7 -7)
If any porlion of the residential structure or the land not exceeding one (1)
of the property utilized to produce in.
come
a that immedia" surrounds that structure is used to produce income, describe the use and potion
County
Township
I hereby certify the above statements are true, correct and complete.
and street, city state,
claimant
/ 6�
Township
�,hkASSESSORUSE ONLY u
TRUETA)t r"r ;s
�VALUE�`hATi100
e^+-
ASSESSEDVALUE.
.�.a -:+�: ..
�7HOMESTEAD'•.
M ..a,. •�cl::..
• NON=RESIDENTIAL n29�° T
�sd.T't'i.VALUE:u+c�dt?t�i�
%'OF,.TTV
.'E�.�RVALUE� s -.�*e.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
3`5`- ,'"- -- ax -_-_.
,.,,.,K
Total land (line 7 plus line 2)
(3)
Dwelling
(4)air.4j''3i"..
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
T i� ^My •) ?
Total improvements (line 4 through line 6)
(T)
Tdal value (line 3 plus line n
(6)
.
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor -
Date signed
?,`_' - STANDARD, DEDUCTION'AL'LOWANCE,._��;fl�;,y ...'>�•.- u`3s��r`.,'"i�_,r ,y.,,R'
20 Pay 20_
Lesser of 112 Homestead 5
valuation or 535.000
Signature of Auditor 7 ate signed