HomeMy WebLinkAboutHomestead_FischerCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
t State Form 5473 (R511041)
u,• Prescribed by the Department of Local Covemment Finance
INSTRUCTIONS: See reverse side for filing instructions. II'1 F1
I (We) ` U V n Y 1 L�./n.// �J certify that on tkht gay of 2M, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead P of erty Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
&Have a beneficial interest in the entity that is gable for the property taxes on the property and that owns the/prdpgftgari ' p{qg" ;[irtdeF-a lontr�dt.
!CONTRACT RECORDED
If buying on contract. Fee Simple owner's name
Recorder's office wham contract is recorded Record number Page
Pi2dWiTY;' �OWNEDBYCL 'AIA1ANTIN;OTHER.'COUNTtE$ °k ...�.*a
County Township
3! ROPERTYrOESCRIP.T10Nr�- �- -'��r.
County
griptor f claimant
Township
Testing district (dry, town, township)
/P,fl(�a n mbar
/B
Leg ey�rn n ^� ^� is the property in question:
�
lJ
(0 " W
(� �J �Ot' • [3 Real property ❑ Mobile Hamo (l.C. &1.1 -7)
portion of the residential structure or the land not exceeding one (1) acre the immediately surrounds that structure is used to produce Income, describe the use and portion
of the property
Total land (Line 1 plus line 2)
Pi2dWiTY;' �OWNEDBYCL 'AIA1ANTIN;OTHER.'COUNTtE$ °k ...�.*a
County Township
County Township
hereby certify the above statements are true, correct and complete.
griptor f claimant
dd ss (number and street, Sate, ZIP code) 12 fffIN
r-f A O A S ON -
3
W UETAX 70
a�AT'700
ASSESSED,VALUE
%d FTTfVry'-
OfdESTEA�
�VALU
'NON RESIDENTIAL -
- ,. '5�'.^VALUE. =?..
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
a` _- -- wit`;
Total land (Line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
�.
.vs�hi3rl
Other improvements improvements
(6)
^�
Trial improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
I hereby certify the above is true, totted, and
complete.
Signature of Assessor
Dale signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $6,000
1 Sgna ure of Pud tor I�^ . ^ IDat Is_ed� -� \I