Homestead_Hursti CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (Ra 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instmclions.
FORM YEAR
HC10
g.,. ttCERTIFIC4TION ;STATEMENTxt ^• "Y".;.�'_9,.._,=
I (We) certify that on the s a ( rch,
'ncipal hLe
(We upied as ou I of reside Ace the following described real property for which a Homestead Property Tax redit cfal,; il:
I (We) owned Are buying under contract 0 C T 1 'r 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 a contract.
Taring di
t
7/-/
s�.tF: •...-.'` n:-.+, •;'l`:�.a',.-bi'�Y"d�kCONTRACT? RECORDED_', >;y.rr�:r`GtB v '�- ;.?`�..,.,-
SONGClr1 -NY, v,.
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded
Record number
Page
`n2�•:
3e- v5n`t' � n PROPERT•Y:DESCRIP..
. _ .
County
Township
Taring di
t
to to
Dim
�aR'.1'.
eai� -r't:V .T
/
Legal description
J g
S
Is the property in questi
[J.Bae o ❑ Mobile Homo (I.C. 61.1 -7) .
If any porlion of the residential SWcture or the land not exceeding one (1) acre that 6mediately
of the property utif¢ed to produce income.
surrounds that structure is used to produce income, describe the use and portion
XAr �CdU`Nff
County Township
County Township
aIiOMESTEAD•i£
-'
• ` (NON- RESIDENTIALy
I hereby certify the above statements are true, coned and complete.
Signat e
f claimant
ddress (number and s t teY< M. stat e, ZIP
ia, ;n,c, &,k &OWA44412 l.��� , U . 467406v0
RA
-TR
ONLY •a4��s�,
E AX�
ASSESSED VALUE
�'AT.�100%
aIiOMESTEAD•i£
-'
• ` (NON- RESIDENTIALy
.ASSESSOR,USE __
, yA_L_UEa"-
OFTTV
r�.<.
VALUEf"'`E+'.
."� ...�-.a�xs.
�aR'.1'.
eai� -r't:V .T
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land``
(2)
Total land (line 1 plus line 2)
(3)
Dwellin g
Oa^��
�° ti
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
:MOM e
y "�_as
3'
Other improvements
(6)
._ W MAR
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of assessor
Date signed
complete.
Verifying action - Signature of auditor
Date signed
r `SS `^r•.. ' y �'�''' ;: >,z tisTIWDARC OEDUCTIOWALLOWANCE„� �� =s;. "H.ir's:.°" �'` .yam` .`•.'.�'
Wi=t �.r is
MV 20 _ Pay 20
Lesser of 112 Homestead
vauatlrm or 535.000
5
Signature of Auditor Da ygned