HomeMy WebLinkAboutHomestead_GettoCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Slate Form 5473 (Re 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instmcliorrs.
°FORM YEAR
t pg 10 2004
t
I (We) Ge �, certify- that on the 1 st Tda' Hof March, 20
I (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
1 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.
I( buying on ContraU. Fee Simple owners name
Recorders office where contract is rewarded Record number Page
. � �.., .. -, .� . -. __,
*.'3s ;` -- ,"FROP.ERTY, OWNED: �BYCL 'AIMANT;IN:OTHER'COUNTIES+,x
County
Township
Testing district (city, town, township)
Pagel nt�ber l�
l/�)/) J
LF,ga sr�
tipn `� _q
W R
Is the property in question:
❑ Real property ❑ Mobile Horn. ( /.C. 61.1 -7)
H any poron of the residential sDuctum w the land not exceeding one (1) acre that immediatey surrounds that structure is used to produce income, describe the use and portion
Of the property utilaed to produce income. t ^ Y ,^ L
. � �.., .. -, .� . -. __,
*.'3s ;` -- ,"FROP.ERTY, OWNED: �BYCL 'AIMANT;IN:OTHER'COUNTIES+,x
_
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signat a claimant
4ddre umber Wt state, ZIP code
\1
q ROOM- -� `.,s;
ASSESSOR USE ONLY r.,.,?'y5
z7a .<.zY y" ,"�'S1,—.. .
. 3 TRUE;TAX
kc> VALUE
i1&0-1, .. __....3...3:
ASSESSED VALUE
�`-�AT 100 %_`OFTTV
.3_ d_...
HOMESTFAR
*- VALUE3
NONRESIDENTIAL 3-
r";'r" VALUES, yi"'r -"'
.s....,u....Is,+,.��
Land not exceeding 1 (one) acre immediately
T cc" -YS.s
surrounding residential Improvements.
Other land
(2)5;i
I-F4v ]�
.,r,.�r. r• -�
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'�%iy.• t„
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
—
. x ,i` ,;+ o
�yL ` K
Other improvements
(b).
d.
-..w�v
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line n
(0)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action- Signature of Auditor
Date si9 ned
WSTANDARD: DEDUCTION"ALL01AlANCE *^,`t���t,}��'y,�;;' free-•; �' � ,�"ei- l'���",E'1.f��?a`�,.,y,.
20 _ Pay 20 _
Lesser of 112 Homestead $
Valuation or 535.000
Signature of Auditor Oate s' ed
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