HomeMy WebLinkAboutHomestead_Falls (4)CLAIM FOR HOMESTEAD PROPERTY TAX FoRnn TEAR
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
R--ERTIFICATICIN,STATEMENT..
I (We) certify that on the tat day of-March, 20
1 (We) occupied as oLurincipal place of residence the following described real property for which a Homestea'Inlry lFCredo-Irterprtaimed:
❑ 1 (We) owned C) Are buying under contract
JU I Ij
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.
���t-�?*,.�l�CONTRACT-.RECORE)ED'4;!�--,,I,*-,-.,�-,.�-.:"��l.-.-�'-
DESCRIPTION
County
Township
If buying on contract. Fee Staple owners name
Taring district (city, town. township)
.17 ICT
GIRPQN
Lega -escai
�TA M" 1&4�L
Recorders atfics, where contract is recorded
Is the property in question:
I ❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
C,,o "NrX
IRecord number
m§W4WALUEa
Page
PR6P-ERTY:'OWNEUi6*,CLAIMANT-,'IWOTHERCbUNTIESi47
DESCRIPTION
County
Township
Township
Taring district (city, town. township)
P I number
U011 � - Q)?CY-:GD
Lega -escai
�TA M" 1&4�L
�0
Is the property in question:
I ❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or the land of exceeding we (1) am that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
PR6P-ERTY:'OWNEUi6*,CLAIMANT-,'IWOTHERCbUNTIESi47
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
dress (number and street, city, state, ZIP code)
nyp -g
ASSESSOR USE ONLX�-,
g
i�Sj-TRUETAXRtP
ASSESSED VALUE
t,��AdM- E'STEWD-.�
NONRESIDENTIAL
Valuation or 535.000
S
'-AT,:l 00% Clf4T.T.Ve�
�0
Q7.
Date signed
5--1
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Land not exceeding I (one) acre immediately
surrounding residential Improvements.
Otherland
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
OaJbetimprovemenis
(6)
Total improvements (line 4 through lift 6)
(7)
Total value (line 3 phis line 7)
(8)
I hereby car* the above is true, correct and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARDIDEDUCTIOWALLOWANCE'e,
20 Pay 20
Lesser of 1/2 Homestead
Valuation or 535.000
S
Signature of Auditor
Date signed
5--1
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