Homestead_HelmbrechtCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R6 f 4-W)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. - -i�1 -Tr -r TN'
' certity tfligeq� the 1st 2Uhf March, 20_
IT) occupied as our principal pla of residence the fol owing described real property for which a Homestead Property Tax Credit is hereby calmed:
❑ 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 th p "inperiy or,is buying,!nder a contract.
. `J�" NTRIiCT.° RECORDEDx° Tt?- a ""�m.�e".'�es'%`I�.°s- '�" -�.s
If buying an contract, Fee Simple owners name
Recorders ofics where contract is recorded Record number Page
-. --
.- ')w_.. ;;�e�y�±- �'.�- rs�`� =�_ "rPROP.ERTY, OWNED. BYICLAIMANT :IN�OTHER'COUNTIES1�..e'
ty
Township
Taxing district (dry, town, to sh
Pary�nu/njer
(f ((�—
Legal description
Is the property in ques on:
property ❑ Mobile Homo U.0 L In
H any portion or the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
or the property utilized to pr i me.
e. V V t�
-. --
.- ')w_.. ;;�e�y�±- �'.�- rs�`� =�_ "rPROP.ERTY, OWNED. BYICLAIMANT :IN�OTHER'COUNTIES1�..e'
County Township
County Township
I hereby certify_the above statements are true, correct an late.
Si f claimant
number and street, till: state, ZI code
y ° -3r
M +z-. °1` ,,. - z ,. �� , 'r
ASSE35OR USE ONLY. ;
� R _ f.i"'/
6�f" >1-UE
�...
E HOMESTEAD
,r�� _
! ,� ,qNONAESIDENTIAL
�.Rz.VALUEu.'�
Land not exceeding t (one) acre immediately
surrounding residential Improvements.
GJ
(2) n
Other land
Z F
` ,fix.q
(3)
(4)
Total land (line 7 plus line 2)
Dwelling
-a %1 -�
#.� N 511 0 r�-�r
Residential improvements or Annually
Assessed Moblb / Manufactured Home
Garage
(5)
_
''
Other improvements
(6)
�•
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line n
(S)
hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20
Lesser of 112 Homestead
Valuabordor 535.000