HomeMy WebLinkAboutHomestead_FredericksonCLAIM FOR HOMESTEAD PROPERTY TAX FqF1 M YEAR
CREDIT /STANDARD DEDUCTION HC1 ot t j
State Form 5473 (Re 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
JUL 12 2004
-`.CER FICATION STAMEMENT1- < MA :W -f
"W —ia , ti-- -4,
I (we) Gl5S0:q1%Ut1(Ty
certify that on the 1 st day of March. 20
1 (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
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.
ONTRACT,
'RECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
0�-'P. ROIR E RTY.-D E S C RVP�T I
County
Township
Township
Taring di (city, con, unship)
I)Aj
Sgnetur of clall at
-4dress (number and street, city, state
d-1 1,6 t
Z -
Par
Pat I u ber
--4�D
d pfic,
Is the limperty, *1 tiestion:
property
...........
Otherland
property Dabile Homo (LC. 6-1. 14)
If any portion of the residents] structure W the land not exceeding we (1)
Of the Property utiliZOd to produce income.
aore that it iatety wnomils that x4iturt, is used to produce income, describe the use and poron
V—RO STANDAREi:DEDUCTION'AL—LOWANCE:'r',:v:. Vie;`- �.�:''
ow 20 _ Pay 20 —
County
Township
County Township=
I hereby certify the above statements are true, wifect and complete.
Sgnetur of clall at
-4dress (number and street, city, state
V—RO STANDAREi:DEDUCTION'AL—LOWANCE:'r',:v:. Vie;`- �.�:''
ow 20 _ Pay 20 —
�4HOMESTEADW;
00 OkESIDEN'
Land not exceeding 1 (one) acre immediately
$
Valuation w S35.000
Or
surrounding residential improvements.
...........
Otherland
(2)
Total land (fine I plus line 2)
(3)
—0
Dwelling
(4)
'6�- rp
Residential improvements or Annually
NOM WkWWWRIII-WW"a.
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
V—RO STANDAREi:DEDUCTION'AL—LOWANCE:'r',:v:. Vie;`- �.�:''
ow 20 _ Pay 20 —
Lesser of 112 Homestead
$
Valuation w S35.000
Signature of Auditor
Date signed