Homestead_HouchinCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (86 14 -03)
Piescl bad by the Department of Local Government Finance
INSTRUC77ONS., See reverse slide for fiffrV kiallructiorm
I'd - I
FORM. YEAR
HC10
ou D::1
AUG 1 2 2005
I (We)
IHave 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.
QNTRACTIRECORDED�—�ft�k-
If buying on contract. Fait Simple owrees name
Recorder's office where contract is recorded Record number Page
MkTY, &WNE E�Erirlc Elij LOA hT I Wbffi ,-4 'W_0
-Ivu 2=a
County
Twmship
Taring d
r)
Parcel number
C!) � (p —
Legal description
b L;-1 L C)C �)
Is the property in question:
PFAI Property ❑ Mobile HMO (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds ffial structure is used to produce income, describe the use and portion
of the property utilized to Produce income.
MkTY, &WNE E�Erirlc Elij LOA hT I Wbffi ,-4 'W_0
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature arVaimant
_VAL!!�IM.
�W
'dress (:F7 and street, state, ZIP code)
15
1 - (It b 5 0 1`1
C(
III
VAO
ONLY orsLi�g�-
E ONLYg
- TRUE
��
OHOMESI��
�- ---I, -
V,�jNOWRESIDENTiA
&rg
9
��1100%TOFT TV--
_VAL!!�IM.
�W
Land not exceeding 1 (one) acre immediately
surrounding residential improvements:
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
1+. 7 V
M
'Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
m
w
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 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
20 _ Pay 20_
Lesser of 1r2 Homestead
Value" or SM.000