HomeMy WebLinkAboutHomestead_ChaneyCLAIM FOR HOMESTEAD PROPERTY TAX
} CREDIT /STANDARD DEDUCTION
,. State Form 5473 (112 / 5 -92)
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INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10 I�
e)1Ol 1Llt t>-) . + aU N • \ 1 certify that on thesI st day of March, 19S
�) occupied as our principal place of residence the following described rea roperty for which a Homestead Pcgpeny Tax Coil is'$e j gaimed:
I(We)owned ❑ Are buying under contract wwlY-�L 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 RECORDED - If buying on contract. Fee Simple owners name. -
Recorder's office where contract is recorded Record number Page
- PROPERTY DESCRIPTION
County -
Tow (
County
Taxing-diIstct rty town, township) -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
�reby certify the above statements are true, correct and complete.
Signatuilof
t(� \J
Parcel number
Legal d iption n ^� n -
-aueee
It any portion of the residential structure or the land not exceeding one (11`)
that immediate- y�ysurrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - -
County
Township
County
To Apship
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
�reby certify the above statements are true, correct and complete.
Signatuilof
claimant
Address (number and street. city, state, ZIP code)
X `731 Dr-. a )CL In N q7wgo
rld
ASSESSOR USE ONLY
TRUE TAX
VALUE
ASSESSED
VALUE
HOMESTEAD
VALUE
NON - RESIDENTIAL
VALUE -
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Valuation or $2,000
Signature of Auditor
Otherland
(2)
Date si ned-5
Total land (line I plus line Z)
(3)
.
Residential improvements
Dwelling
(4)
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 obs line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
&ing action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
19 _Pay 19_
Lesser of 1/2 Homestead
$
Valuation or $2,000
Signature of Auditor
Date si ned-5