Homestead_Cochrane (3)i I ) YEAR
CLAIM FOR HOMESTEAD PROPERTY TAX/) - I
tAJUT
CREDIT /STANDARD DEDUCTION C
State Form 5413 (R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for Wiwi urmutctoms
-CERTIFICATION STATEMENT %,
I(We)
certify the 1, s 20
PS
I (We) occupied as our principal place of residence M Mid
❑ ce the following described real property for which a Homestead Prope y ax re I is nerA,
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.
CONTRACT RECORDED'
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
'�PROPERTYDESCRIRTION
County - I Toomship T-Twi--o—disit W- _( Fity, tq—, )9-mthip) /7 _/57 P/
If any portion of the residential structure or the land not exceeding we
of the property utilized to produce income.
County
Township
��I�here,by certify the above statements are true, correct and complete.
iftdra
es (number and street. C& mate, ZIP wde) A I
Is the property in question- U
gReal property ❑Mobile Homo (LC. 6-1.1-7)
Wm/*1y stmr',
i4amnr/4d
71,Wnrounds that structure is used to produce intxurie, desaibe the use and Portion
Township
Z;.
TRUEiTAX,-,-
20 — Pay 20
�if '
Okl3fCA61��
'*'Er.7-ty'kON-RESIDENTIALi
'ASSESSOR USE ONLY ;i-0. T�
-V AlL
VALUE
'tAT,100WOFT.TVA
V_=kWALUE
VALUE
$
Valuation or 535.000
Signature of Auditor
Land not exceeding 1 (one) acre immediately
Date signed
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Motile / Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
1W_I value (fine 3 plus line 7)
(8)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
or
Verifying action - Signature of Auditor
Date signed
STANDARDZEDUCTIONALLOWANCE-k
20 — Pay 20
Lesser of 112 Homestead
$
Valuation or 535.000
Signature of Auditor
Date signed