HomeMy WebLinkAboutHomestead_Lee (3)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614 -03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (we) I U certify that on the 1st 11d''ay o ffMI3�arch, 20
I (We) occupied as our principal place of residence the following scribed real property for which a Homestead Prop Tax ErEditihbfeby daimed:
❑ 1 (We) owned ❑ Are buying under contract // /� (n�
l Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns t '" roe ris bu " 'under �rpn�iaIX.
heft, A_rtY,4_.L rieg� w
s '•',- .`C-''%x`„4.'`CONTRACTRE_ CORDED'- x'- ?',c9,,,,, «;k�+C+�;r'Y- ;c:,a`2
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
?$`iw'=S.i 7 °v+ ."' tPROPERTY_OWNEDTBY CLAIMANT •IN'OTHER'COUNTIES i V'',s f `
ROP,ERTY:DESCRIPTION'sc�.^'� "°-;= {E- `- v"��'">i' X- '•'�'".✓r^xa" r -f .
County
Township
hereby certify the above statements are We, correct and complete.
Taring district (city, town, fownahip)
Parcel number
L deeslcri
ter.; •VALUE
I property in question:
Land not exceeding 1 (one) acre immediately
`
e? ❑ Real property ❑ Mobile Homo ( /.C. 61.1 -7)
H any portion of the residential structure or the land not exceeding one (1)
1cre that immediately sunounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
?$`iw'=S.i 7 °v+ ."' tPROPERTY_OWNEDTBY CLAIMANT •IN'OTHER'COUNTIES i V'',s f `
County
Township
County Township
hereby certify the above statements are We, correct and complete.
'tin ture or cla fit
Address (nu) er nd street, city, state, ZIP code)
0 m 660
20_Pay 20_
Lesser of IQ Homestead
vauaaon or 535.000
$
Signature of Auditor ` Date signed) - O
A)(
ASSESSED VALUE
MESTEAD -`
HO
�"'�eNOWRESIDENTA
. - r-^ ifEn "s"tES'RUSS"'a3N.�aTt- x'..,.t
'u'•r .+.VAGUE- c.<,y`1AT�700
%.OFmTIV�
ter.; •VALUE
Sri 3'VAIIUE� -at_9'
Land not exceeding 1 (one) acre immediately
surrounding residential im rovements-
Other land
(2)
"- f2- �"7's7"
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
5
()'
w%y
Other improvements
(6)
is
Trial improvements (line 4 through line 6)
(T)
Trial 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
20_Pay 20_
Lesser of IQ Homestead
vauaaon or 535.000
$
Signature of Auditor ` Date signed) - O