Homestead_LloydCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614 -03i)
Prescribed by the Department of Local Government Finance �j 1��'11
INSTRUCTIONS See reverse side for filing instructions. L '} r
t '?" '"Zx:1 f'_ i+ � .4 CERTIFICATION- STATEMENTia,.s "'T�"�' {.c ti lj � y- 2 s '
I(We) JUN 10 $�V4
certily that on the 1st da o March, 20
I (We) occupied as our principal place of residence the following descrilled real property for which a Homestead'Propertty Tax Creditiis hereby claimed
❑ 1 (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property Y taxes on the rop e r ty and that owns p'eVor I r igun j r a contract.
If buying on contract. Fee Semple owners name
Recorders office where contract is recorded Record number Page
��yt IWQIIV M�i,. ,:, ,;.P.ROP,ERTY;RESCRIP.TION`':, nom: .,,'A jam"` y, yyy�cr2"
County
/
Tonship
County Township
Taxing district (city, town, township
Parcgl qu
/l1/1
rpber
IY,/,
escri Gon
Is the property i estion:
Real property ❑ Mobile Home (l.C. 6-1.1-7).
H any portion of the residential structure w the land not exceeding one (1) acre
Of the property utilized to produce income.
at immediatety wrrounds that structure is used to produce income, describe the use and portion
`Y..°- PROP.ERTY;OWNEDBY;CLAIMANT,IN OTHER` COUNTIESi� '= ?xf_- '.'`_.a`'`;�„V'y'-�'•d
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Si a r aimant
r ss (number and street, city, state, 21P code)
av ASSES50R EONLY 'rt
,rsr,`r{, �-'. -rah„ `;:rr ^��.. ;,t,•a„
TRUET ,
..7,,,•xVALUE;s
ASSESSED ALV UE
mATc100 %'OFTIVsz.�VAL'UE
HOlAESTEAD
eNO�N iESIDENTViL ti
F��1u.:aMVAL.UE�'' ���
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
2`'
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
v b
Residential improvements or Annually
c
Assessed Mobile I Manufactured Home
Garage
(5)
ft; �� r
Other improvements
(6)e
�ry
Trial improvements (line 4 through line 6)
(7)
Trial 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
:s
_ Pa20 STANDARD.DEDUCTION'AL'GOWANCE
20_Pay
Lesser of 112 Homestead $
Valuation or S35.D00
Signature of Audhw Date Zed