HomeMy WebLinkAboutHomestead_Kramert CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
I (We) I I 0 ! N ACIE /YYND A certify that on the 1st day of March, 20_
I (We) occupied as our principal place of residence the following described real property for which a Homestead Propimax1c*Mreby claimed:
❑ 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 the propeny.or -is /buying under a�contract.
eCONTRACT.' RECORDED; s` r�. s'" 3''''= '=*e''a.''" "-f'';y'�'.°'x
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
rwt' �a_'-° a6rsalr` va? P, ROP, ERTY- :DESCRII?TIONE?'., ?°'5"' -"`' It r
County
Township
Cou Township
Taring district (city, town, township)
P r
�V V
L de n
property in question:
�! / ❑Real property, ❑ Mobile Homo (LC. 61.1 -7)
If any portion of the residential structure or the land not exceed' g
of the property utRzed to produce income.
is 1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
Y3hg ^-
ASSESSOR�USE ONLY, y& c—.VAL'UE�:"y'eAT.�100
County
Township
Cou Township
I hereby certify the above statements are true, correct and complete.
natur
j6dre ( tuber (reef, 64t state, — "code)
Y3hg ^-
ASSESSOR�USE ONLY, y& c—.VAL'UE�:"y'eAT.�100
`{"rTRUErTAX
ASSESSED VALUE
%'OF'TTVy
HOMESTEAD
VALUE6°•,ygLU.'r'
N N ESIDENTUIL
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Y^'
�-P
Other land
O 2
Total land (line 1 plus line 2)
(3)
_
Dwelling
(4)
lox
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
If
malli IN
Other improvements
(6)
a'- '
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line n
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Dale signed