HomeMy WebLinkAboutHomestead_Kinsmanrt t CLAIM FOR HOMESTEAD PROPERTY TAX FORM nn YEAR
CREDIT /STANDARD DEDUCTION Hcio 1 \
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instructions.
e'.??i. "-i �`,.'_;rds s'— "'«,,:a= ct= "�,C_ ERTIFICATION _STATEMENTi=X.7iy,�¢,
certify that on the 1st day of Mar , 20_
1 (We) occupied as our principal place of resid rice the following described real property for which a Homestead Pro")kyTax Clqdf2Offfereby claimed:
❑ ](We) owned ❑ Are buying under contract - ODULL
a beneficial interest in the entity that is liable for the property taxes on the property and that owns
If buying on contract, Fee Simple owner's name
Recordefs office where contract is recorded
Record number I Page
•- ASSESSORUSE ONL=,r ''''TRUE
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County
Tonship L
Taring district (ci (o hi )
i
Parcel number
Legal description
Is Ne property in question:
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Real property ❑ Mobile Home (I.C. 61.1-7)
If 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.
•- ASSESSORUSE ONL=,r ''''TRUE
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County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sig ature of claimant
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dress (number and street, city, state, ZIP code)
101A-1,41 S L ,✓b C-1 _7 IAI
•- ASSESSORUSE ONL=,r ''''TRUE
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ASSESSED VALUExHOMESTEAD
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`NON-
RESIDENTIAL.:i''s
._'1
$
._µAT ;100 %..OFTTVr
,TtVAL, UE�
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Land not exceeding 1 (one) acre immediatety
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surrounding residential improvements.
Other land
(2).'`
-'c
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
"i, r�'
ok 6VIS „� �' *� MH
Residential improvements
Garage
(6)
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�i'hrd�i�'i33P4- ;con r`- 'L
Other improvements
(6)
Rr-.`':3su:
Trial 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
Data signed
complete.
Verifying action - Signature of Auditor
Date signed
FAY' ^K fo - ' 7.'; STANDARD.DEDUCTION:AL'LOWANCE, 'T"”' ..y..- ',•; -t' �"' 5. ,E v+3 . >s,d<.__:.=
x; �`+s
20 _ Pay 20 _
Lesser of 1/2 Homestead
$
Valuation or $6,000
Signature of Auditor
Date signed