HomeMy WebLinkAboutHomestead_Cox (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDITISTANDARD DEDUCTION 5P Hc�o
State Forth 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS., See reverse side for riling instructions.
YEAR
R JL L..1 -&--f �
I (We) fl0 M c4zp certify that on the 1st day ) of March, �2r01(T�
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax CfeW Is h2rAy 2lQ d:
❑ 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 7 urdenaa--contracl
,,.
ONTRACT. -'RECORDED?i�i;V"J' -:a:s r;r'- ''S` #kt'�'�*ty'.r �°11��'��:'- '��.x�- •,:�"� a7;2
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
County
Township
I hereby certify the above statements are true, correct and complete.
'
-,� �..tASSES50R USE ONLY' ? ��
County
Township
Tadng district (city, town, township)
Parcel number
I 104 0 O
�,
Is the property in question:
100% OF -TV_„r
1/e
1
El Real property ❑ Mobile Homo (LC. 61.7 -7)
any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the^operty utilized In produce income.
Date signed L Vm
County
Township
I hereby certify the above statements are true, correct and complete.
'
-,� �..tASSES50R USE ONLY' ? ��
--- TRUETAX'-
` i
'�.,r
ASSESSED VALUE
-`AT
'aHOMESTEAD�
rDt,� NONE- RESIDENTIAL
VEN .�.rNi."FJ Y.y.,.l.`. -t F_'r dv
VALUE;
Y�iJa._Y
100% OF -TV_„r
�i _VALUE ?c��',
R�.Y.A+yr -.
Land not exceeding 1 (one) acre immediately
Date signed L Vm
` FYr ={- ,'sit•'"
surrounding residential improvements.
Other land
(2).`"?r""
Total land (line 1 plus line 2)
(3)
Dwelling
(4 )
'`y'm" 7;
—MEM '
(Residential impro vements or Annually
'ine4'i "O'
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
.''fin` �^`1 �'
S'i, •fr;.� T
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature oflwditor
Date signed
'��rSTANDARDAEDUCTIOWALLOWANCE. x,'.;?Ftii/ .wp 'i�,`i�r'`s '. '.e --- _ +�t o„`�,f<'
20_Pay 20_
Lesser of 112 Homestead
$
Valuation or 535.000
Signature of Auditor
Date signed L Vm
U d