Homestead_Cochren (3)f,
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION H'0
State Forth 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for!ling instructions. U ( j 7 2003
I (We) up" as our princip pi of residence the following described real property for which a Homestead ISfi rt�IrtauQYetlits hereby daimed
❑ (We) owned ❑ Are uying 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.
__ NTRAC _
COT.'RECORDEO-
If buying on contract, Fee Simple owners name
Recorder's office where contract is recorded Record number Page
-u'm"
'' - PROP. ERT. YOESCRIP' PIONi?5- i"..- =.,.i.,c`"er'•f'' "$;`'s
County
Township
Taing diet (city town, township)
Parcel number
qq-
L al ascription /^/_/—, 2
rty in Is the prope stion:
Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding )acre ddyI immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. 7
6L' AIMANTINbTHERCOUNTIES.- ?�?�?'-'���k
County Township
County Township
I hereby certify the above statements are We, mirect and complete.
Signpturre of claimant
X !/
Address (number and street, city, state, ZIP code)
,a Lei rai _try
AS8ESSOR�USE ONLY _i�
qp. atcP+eN
3iTRUESAX
.ASSESSED VALUE
-�
HOMESTEAD
uiwaf� {� „(
--NON= REStDENTUIL��S�"
'jt
ATk700 %_OFTfY
VALUE. r
- :�VALUEyz
Land not exceeding (one) acre immediately
u
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)���
Residential improvements or Annually
Assessed Mobile I MamlfaclU ed Home
Garage
(5)
+i
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 phs line 7)
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20al Pay 20 O
Lesser of 112 Homestead
valuation or 535.000
b