Homestead_LepeauCLAIM FOR HOMESTEAD PROPERTY TAX FORM _ YEAR
— CREDIT /STANDARD DEDUCTION HC10 -
State Form 5473 (R614-03)
.Pre ed by the Department of Local Gowemment Finance
IN UCTIONS: See reverse side for riling instructions.
CERTIFICATION STATEMEW. i }. • �`
I (we). certify that on the 1st day of March, 20_
1 (We) upied as our principal place of residence a following described real property for which a Homestead Property Tax Credit is hereby daimed:
I e) 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 property of is tiuytng under a Wnbactrr4�,
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded
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PROPERT.Y.%DESCRIPT 6 -."—..
,:�;���,,. �� ,.� x; .!$:�: - PROP.ERTY,OWNED'BYCL'AIMANT;IN! OTHER "COUNTIES,f�..��_°.`'�r:� "�'»�''��C'4�, g•'n"•'�fi
Count
*'W "WAR -e
County
Township
Signature laimant
Taring Uu:t ryfto ,own )
a umbv�/�
••/�/I
L eswiptiop
fP
as
Is the pro perty
R .party ❑ Mobile Home (LC. 6- f. r -n
H any ponion of a residendal sW cNre w the land no xceeding one (1) acreftihat'immedfate
of the property utilized to produce income. C�
surrounds that structu used to produce income, describe the use and portion
f6tk 47 q
,:�;���,,. �� ,.� x; .!$:�: - PROP.ERTY,OWNED'BYCL'AIMANT;IN! OTHER "COUNTIES,f�..��_°.`'�r:� "�'»�''��C'4�, g•'n"•'�fi
Count
County Township
It ereby certify the above statements are W e, corned and complete.
Signature laimant
Address (number and street, ate, ZIP code)
Signature of Auditor rIlf I
Dat i etl
s -o
tASSESSOR UUSE ONLY i}�,
c TRUE TAX , f
'��.r
ASSESS Y UE
MESTFJID r'
�'
NON-RESIOENTWL, .?
�� �t
4VALUE;- »
_.. xV.'
"`AT4100 %. TTVaf
v.avT
F =VA_ LUE�
�
"4_ '� <'vr
+VALUE �
Land not exceeding 1 (one) acre immediately
` r r y 'y,.- '',- 3•n,'I'
surrounding residential improvements.
Other land
(2)NS€'
' -2l•3
Total land (line 1 plus line 2)
(3)
Dwelling
'Vf,"tzir
Residential Improvements or Annually
Assessed Mobile / Manufactured Hone
Garage
5
`• �'` - ^*-cti`
_,i::
rY.
Other improvements
(6)
s
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true. corned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
• .'a.,.> t` r "-; =t; y ,�-6�s�STANDARD .DEDUCTION "ALLOWANCE � a x . •y i 6�,�1%%'.
20 _ Pay 20
Lesser of 112 Homestead
$
Vaua or $35.000
in i
Signature of Auditor rIlf I
Dat i etl
s -o