HomeMy WebLinkAboutHomestead_Graham (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDITISTANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for hibng inslniclions.
C RTIFICATI
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I (We) cam at.'on theAst day,of Marchf20
I (We) occupied as our principal place of residence the following described real property for which a Homestead Pro edy Tax Credi[ is hereby claimed
❑ 1 (We) owned ❑ Are buying under contract t 12 2003
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
If buying on conuacl, Fee Simple owner's name
Recorder's office where contract
Record number I Page
iilll @'°SY�+
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C� �S.eu'riHn
',- ,�P,ROPERTY:DESCRIPTIONt?.w? - _ _ �,,;,,: aw4'fmfmf`''-
County
Township
Township
Taxing district (city, town, township
Signature cdVaimant
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Pryl nymV ��
/.,l
—thee
Legal de do
lASSESSOR!USE ONLYx =-
TRUEsTAX,3r
VA_L_UE
Is p
tm -!Real property El Mobile Homo (I.C. in question;
If any portion of rWesiddelnl6a strucure or Ue land not exceeding
of the property utilized to produce income.
a (1) acre that immediately su )ds that structure is used to produce income, describe the use and portion
-2
_��r;.a4?` -� ����.�"'?�- �`�'�PROP,ERTY 0111INEUrBY CLAIMANTIN'rOTF1ER' COUNTIES .`�..>- �'z��`Y'Yr-r$�{`�
County
Township
County
Township
I hereby certify the above statements are We, correct and complete.
Signature cdVaimant
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Ad (number and street city, state, ZIP code)
$24 HI61-1LAN1, bikiVC 0AKLAND CITY IN 47(1&0
lASSESSOR!USE ONLYx =-
TRUEsTAX,3r
VA_L_UE
ASSESSED VALUE
ATx100 %a'OFhl7V
e3sHOMESTEAD
� VALUEP�
e�:.r
NONRESIDENTIAL �4
r a VALUEW1`
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
h '
- , a -#
W. u3
Total land (line f plus line 2)
(3)
Residential Improvements or Annuagy
Assessed Mobile / Manufactured Home
Dwelling
Garage
a
(4)
(5)
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5� A=
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line i)
(6)
hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1Y2 Homestead
Signature of Per /-A O6 / (\ / A O, - /1 0 / / I Date sigTr - /J -6A, -3) ,�