HomeMy WebLinkAboutHomestead_HilligossCLAIM FOR HOMESTEAD PROPERTY TAX FORM VE
CREDIT/STANDARD DEDUCTION
State Forth 5473 (RB /403)
Prescribed by the Department of Local Government Finance f L
INSTRUCTIONS: See reverse side for hlinq instructions. JJJJ1lll
1 (We) G' LL7� //� l / /t /i �I/! Q ��.l� certify that on -the 1st, day of Marc h. 20_
lcctw- ✓t ✓✓��+- --
I (We) occupied as our principal place of residence 6 following described real property for which a Homesteadfrpperty;Tax;Credit ishereby claimed:
❑ 1 (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
?CO_NTRIiCPR_ECO_R_DED_S
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
�-t�,— "`"-- `� -h'.- PROPERTY, OWNED'; BY.; CLAIMANTcIN.' OTNER' COUNTIESF..,,__ "''...,."?s't- `- '�€c- ."�'y?yT�`
RTYIJESCRIP, TION' ss_`',' L, as'�- `.°''3'af,,r�:9u°'%°�v`,'.
County
Tormship
Testing district (city, town, township)
Parcel number �/",�
o16- — (fV
Legal description
Is the property in question:
❑ Real property ❑ Mobile Home (LC. 6- 1.1 -7)
H any portion of 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
of the property utilized to produce income.
�-t�,— "`"-- `� -h'.- PROPERTY, OWNED'; BY.; CLAIMANTcIN.' OTNER' COUNTIESF..,,__ "''...,."?s't- `- '�€c- ."�'y?yT�`
County Township
County Township
hereby certify the above statements are true, correct and complete.
Si ature of claimant y r
ddre number agreet, city state, ZIP code C7,�0
Mir .�3 rye•
+g7}'- ,'ASSESSOR�USE ONLYy+%""f
ft -
�'-;
1UETAX
_ `�"
.ASSESSED VALUE
} HOMESTEAD•
7Y i
NON - RESIDENTIAL
.S'lffi::...
E VALUE..
00 /=.OF`TTV
VALUE,-
%VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'yyF=
F5. ' u•
Residential improvements or Annually��a:e�tf
Assessed Mobile / Manufactured Home
Garage
5
i
Other improvements
(6)
Pi--'NOM rat:
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(a)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
DARDMEDUCTION'ALLOWANCE. -a+^ za}r•".1 ,"H:; m . s�4 `•
20_Pay 20_
Lesser of 1/2 Homestead 5
vatuatton or 535.000
Signature of Auditor Date signed