Homestead_Fosternn
e CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Farm 5473 (RS 11D-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instruclions.
10WR -1 ,a-..3, °'• tdr eiu 4a " = a T "C CERTIFICA ON STATEMENT �a
I (We)
I (We) upied as our prindpal place of residence the follovring described real property for which
I (We) owned ❑ "Are buying under contract
n4ave a beneficial interest in the entity that is liable for the property taxes on the property and t
FORM �A YEAR
HC10 fIl
ANK Z y ZUUZ
certify that on the 1st day of March, 20_
:stead PropepYTax Credit is,fierebv daimed:
under a contract.
NTRACT.', RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
P, ROP ,ERT.Y.DESCRIP,TION9��`?.4T -=r „�. �<. u�,� . ^'
'` -�- -a -''.'. '_rte" '"fir -'?c a ;. �?r"s _ r
County
Tovnship
County Township
Turing rct ('ry, town, towmitio
Pagel nufnber -/t
L//I i /I�iJM/ 1
Leg I escripon
J(
h� ?
the property in question:
❑ Real property ❑ Mobile Home (I.D. 61.1 -7)
If any portion at the residential structure or the land not exceeding one (1) arse that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
r
�-- ";'ASSESSOR�USE ONLY �- -
County
Tcmmship
County Township
I hereby certify the above statements are true, correct and complete.
Si nature of claimant - -
adress (number and street, dry, state, ZIP code)
�-- ";'ASSESSOR�USE ONLY �- -
s '-
ASSESSED VALUE
'�- HOMESTEAD
z -�.-sy
NONE- RESIDENTIAL°"'
L
z �
fir,. ,,�,F,
VALUE
ATr100YeuO iT7'V
y�VALUE
VALUE' ., `
Land not exceeding 1 (one) acre immediately
lI/YI r /C• //
surrounding residential improvements.
Otherland`"
(2)
5 �
a
Total land (line 1 plus line 2)
(3)
Dwelling
(4)'#`'u"'raRt`x.
r,�..,T�, y.,,' }'t4gr 5?I.• TNS'S
Residential improvements"�''�'�'•
-'
Garage
(5)
'"...ifer7 t D.s"s"?.,4 r
Other improvements
s C-i;;—
jw'3'
(6)
�+
_] �
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line n
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
3 1 ,'rgSTANDARD' DEDUCTION' ALLOWANCE-. x">, xi-> p'.', vXy °ec°�va�s-- �'-",_ *,,.rEy'Y`,.rn
20_Pay20_
Lesser of 1/2 Homestead
$
Valuation or $6,000
Signature of Auddo i 7
Date signed
lI/YI r /C• //