Homestead_DienhartCLAIM FOR HOMESTEAD PROPERTY iAX
CREDIT /STANDARD DEDUCTION
N d"
Stale Form 5473 (R614 -03)
Prescribed by the Department of Local Govemmem Finance
INSTRUCTIONS: See reverse side for filing instmr-lrorrs.
FORM � YEAR
HC10
t
- '� CERTI ICATION A MENT� � - '- .- •
I (We) rtity that onntthheee 1 st day of March, 20
1 (We) d as o r principal place of residence the following describ real property for which a Homestead Proper T C�dl s her Irgpd;
I (We) owned ❑ Are buying under contract 1 t— llOeZT� ®jJ
n 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 ra
"=�a r..�fc3,ti : "i t7- :' -^•_, .. .?;.e _x'' rs:'".: "CONTRACT. ..RECORDED ................ -
If buying on contract. Fee Simple owner's name
where contract is recorded
ER
PROPERTY bWNED BY CCAIMANT,IN bTHER- COUNTIES -° :
:PROPERTY DESCRIP.TI
County
Township
County T
Taxing disc (city, t wn, tow shi
Township
�]
/ 6—
Legal description
Is a property in question:
0
I hereby certify the above statements are true, correct and complete. i
ignature of claimant
eel property ❑ Mobile Homo (I.C. 61.1 -7)
I(any po ion at 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 property utilized to produce income.
PROPERTY bWNED BY CCAIMANT,IN bTHER- COUNTIES -° :
: -.. ^#'•€; ; - _ 'r: r -`=
County T
Township C
County T
Township
I hereby certify the above statements are true, correct and complete. i
ignature of claimant
Address (number and street, city, stale. ZIP code) -
TRUE TAX ASSESSED VALUE : - HOMESTEAD' NON - RESIDENTIAL:,
ii�4 :.:' ..- VALUE AT 100 %OF..TTV, [: %- VALUE •, =� - . -...5- VALUE; --
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land (2) •- -
Total land (iine 1 plus line 2) (3)
Dwelling (4) -
Residential improvements or Annually
Assessed Mobile f Manufactured Home -�4 - -
Garage (5) _ .._..
Other improvements (6)
Total improvements (line 4 through line 6) (7) '
Total value (line 3 plus line 7) (6)
I hereby certify the above is (rue, correct, and Signature of Assessor Date signed
complete.
Verifying action - Signature of Auditor Date signed
STANDARD. DEDUCTION ALLOWANCE- -. ....
20 _ Pay 20
Lesser of 112 Homestead
5
vzt anon or 535.000
Signature of Auditor Dar sig
g 0.5
i - - -\ , r El - -------- -
STANDARD. DEDUCTION ALLOWANCE- -. ....
20 _ Pay 20
Lesser of 112 Homestead
5
vzt anon or 535.000
Signature of Auditor Dar sig
g 0.5
i - - -\ , r El - -------- -
i - - -\ , r El - -------- -