HomeMy WebLinkAboutHomestead_CrumeCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (Re 14-03)
Prescribed by the Depanmem of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
10
F - H
up q u gnna
I (We) C�J gnijytf ) ajengcost•da't- idbrch, 20_
�1T. 1
,,,I --- „,(///We) occupied as our principal place of residence the following described real property for which a n@'si�a2lProperly Taxl`Ctledi S'Weby claimed:
pal 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.
wj.i°Te">,':' CONTRACT.'. RECORDEDr� '- §Y7- +aaiF?'"'-•:ct,...1.
If buying on contract, Fes Supple owroes name
Remrdees office where contract is recorded Record number Page
s."{._? ?ifi, �e..• �v�. ?a'",_ 4..”
rs' �s.- r'', j. vPRUPERT :YDESCR)PTIONrz ?��k".'`.`q:.J
Coup
Township
Taung dis (ci ty to townshi
Par I number _ /
Le de ption ^ _,!/)
Is the pro uestion:
l/l!-ch('/ls/
Real property ❑ Mobile Homo (l.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one of ) e that' ratelpsupo ti
unds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. f /( /a l� / O . S-
a.Y'..`- R6P.ER:TY; 6WNEDBY,CLAIMANT- iNiOTHER: 000NTIES. n` 3. ?'' ??,,.? '_f3+`.`�i.""�i.- ''1,- +.T,. -9`. s:S
County Township C
County Township
I hereby certify the above statements are true, correct and complete. \
\Signature of ant
Addydss (number and street, city, state, 21 cad)
'j CL 79. -j
ASSESSEDNAUIE+HO ESTEAD NONtESNENTUIL cr.?
" RrUSE ONLY $•- VALUE °%1T 100 ED.IV SV : „VAL'UE t L r 1
%:fin?aYT�t;..r 1,. �i i VAIUE,,�sr5sastaC
Land not exceeding 1 (one) acre immediately 1 �`,,�,
surrounding residential improvements. O ;? ":-
Other land 5- -•
Total )and (line 1 plus line 2) (3)
Dwelling (4) "i'- :4.t•�� -� .,..
Residential improvements or Annually
Assessed MobBe I MernAachired Hama Garage
5
• :'�;:i" rF:.�i
Other improvements (6)
Total improvements (line 4 through line 6) (T)
Tcial value (line 3 plus line n (8)
hereby certify the above is true, coned, and Signature of Assessor Date signed
complete.
Verifying action - Signature of Auditor Date signed
�STANDARD:DE13UCTION "ALLOWANCE
20 _Pay 20 _
Lesser of 112 Homestead
vau 535.000 $
Signature of Auditor tmon a Date signed
�STANDARD:DE13UCTION "ALLOWANCE
20 _Pay 20 _
Lesser of 112 Homestead
vau 535.000 $
Signature of Auditor tmon a Date signed