Homestead_Gray (4)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM YEAR
STATEMENUOV_+ Uv - 2 •
,j, MAKAL, _ �
I
(We) rtify that on �e 15 .1 ay of March. 20
r' 's "'March,
rinil 'place of residence the w g described real property Ho edit b
I (We) occupied as our p rty for which �a p( e it is ay
aimed:
Ty AUDITOR
❑ 1 (We) owned Are buying under contra ITY A1,101TOij
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.
CO RACt.RECORDED wfi � 6
If buying on contract. Fee Simple comers name
Recorders office where contract is recorded Record number Page
14WI
UETAX
County Township
Court
Township
Signal a of cAnant
T di
i town, to ip
Parcel IlWnber
L at descnPlion
/I
is the property in quesfion
roXReal
-do
�'4LI au 9 a+
ppj
props Mobile Home (I.C. 6f.1 -7)
If any portion of the residential structure or the land not elceeding we (1) =a that
mediate surrounds that sir=m Ls used to produce income, describe the use and portion
of the property utilized to produce income.
Z�N�
Other land
(2)
16 a
-COO - L5 ( IrX-T -7
14WI
UETAX
County Township
I County ITownship
I hereby certify the above statements are true, correct and complete.
Signal a of cAnant
jgre:?r�rxiot city, state ZIP a) U
- - _ _T�
14WI
UETAX
ASSESSED VALUE
HOMEST �
NO W RESIDENTAL
)
W
R s 9' UAW-
Y�
,
vAK.
Land not exceeding 1 (one) acre immediately
IBM-
surrounding residential improvements.
Z�N�
Other land
(2)
M
Total land (line I plus fine 2)
(3)
Dwelling
(4)
ANEW
,
Residential improvements
Garage
OWNS:,
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed