Homestead_Edrington (6)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. /o
I (We) `1 C r � , certify that on the 1st day of March, 20_
I --(We) oocyupied as our principal place of residence the following des "b d real property for wh a Homestead Property Tax Credit is hereby claimed
LIGr(We) owned ❑ Are buying under contract
` e 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.
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
�' �°, x":' s, ��" r%• �` r: �',`' s�. �= 2: �e-'_' ���'. n�PROP ,ERT.I!�OESCRIPTION#%�.:"f �.! rx.`'. '`c°.'..c�r- `r2*�"'�'.y�akr -_e_ s- _�.`
County
Township
Taxingpiildct (city fawn, ow�npship)
Parcel number
Pa
Legal description
J
Is the property in ques'
/ -
9
014taal wewro ❑ rno6ne Romo u.a 8.1. 1-7)
of th e 0� of the residentlel structure or the land not xceeding one (1) acre mat immediately surrounds that structure is used to produce income, describe the use and portbn
property utl'¢ed to produce income.
d 1 -13 -1 you cc /.z77"" 7
40 P, ER7YOWNEDiBY' Cl'' 111M. 4NT. INiOTHER "COUNTIES''r. #'r.,, +J7��
County
Township —
County Township
NON+REStDENTU_1L .X
g'Aa:.9R +.1aci'Fi'
VALUE
hereby certify the above statements are We, correct and complete.
Sig re of claimant ,
Address (number and seeet,.city, state, LP code)
Ih
• + r k" � •y: ;;�•
?„
TRUE'TAX
ASSESSEDNAALUE-
HOMESTEAD
NON+REStDENTU_1L .X
g'Aa:.9R +.1aci'Fi'
VALUE
�`AT 100°b'OF'T3Y
c'', WE [>
._�s- _�.s'.
<"'t3 "S *'rYALUE$f�y.
�.a�.0 >t: ..,,..cY•7La+..s2.'_"
Land not exceeding 1 one acre immediately
surrounding residential improvements.
Other land
(2)
fi:fc`65
Total land (line I plus line 2)
(3)
Dwelling
(4)
IR
Residential Improvements or Annually
Assessed Mobile I Mantifectured Home
Garage
(5)
)ysLW2,_`._
DIY-
Omer improvements
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
. rr�iSSi�fF 'ra',3?SY''= .'F�tzc"'wxy3cC^i�� STANDARD _DEDUCTION'A110 "WANCE' o:'.., } "_'. -Sn fs 4%tM4 -ter a_ .= �:>d4r"��.•`r?.;.:._:>
20 _ Pay 20
- Lesser of 112 Homestead
Vriuebon or 535.000
$
Signature of Auditor -
Date signed