HomeMy WebLinkAboutHomestead_MarshCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEA
} CREDIT /STANDARD DEDUCTION HC10 a�a�
State Form 5473 (Ra 14-03)
Prescribed by the Department of Loral Government Finance Fj
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NSTRUCTIONS: See reverse side for filing instructions.
I (We) y. j /L �/� 7�// .([�. certify that on the j1 st day of M , 20
I (We) occupied as our principal place of residence the following described real property for which a H estead Property TaR Credit I e /by daimed:
❑ I (We) owned ❑ Are buying under contract qq OOD TY Ax3pITOR
Have a beneficial interest in the entity that is liable for the property taxes on the property and that oAlt Se property or is buying under a contract.
- �3CONTRACT.- RECORDED
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
a' r' K.
S'# PROPERT. I' s0E5CRIPTIONs?3 ,°3 =5Am`°:.' >i�v??gi':•k
County
Township
Taxing district (city, town, township)
Parcel number
��(p -. 7
Legal description ('�
Q-t
Is the property in question:
Real property ❑ Mobile Homo(I.C.6-1.1-7)
If any portion of the residential structure or the land not exceeding one ) acre that immediately surrounds that s cture is used to produce income, describe the use and portion
of the property utilized to produce income.
' �'.>: ��i� `_�4s�•3'r.?'?���.��`e}s`?<^' PROPERLY ;OWNEDBY,CLAIMANT:'IN'OTFiER" COUNTIES ';�',�?�$��3T'a�r.a``s_- "��.�!- �s�+r""�$
County
Township
County Tavnship
I hereby certify the above statements are true, correct and complete.
ignature of claimant
Address (number and street, ci()t state, ZIP code)
"US°$ RE '
OR sF ' ON.Ls Y •
E
IAL
'j t -NON- ,> RVEASLIUDE N^Ts
w i`g :3' ? ,..A.r.'�STS&ms . -E &"S'S, nr .a
ae_ ;U
A00 m`HOMES.TEAD!n
jT %,FTu
U.W
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Land not exceeding 1 (one) acre immediately
(1).'"
�sf•`�„'*`'+^,�r�`v- ��'S"t%'
'nrnu:.`k� } {�
surrounding residential improvements.
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Other land
(2)
,'
d2
Total land (line 1 plus line 2)
(3)
Dwelling
(4 )
;
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
r r .- .mit'r -r
�� m'
J 1:
Other improvements
(6)
=�y%
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 pits line 7)
(6)
I 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 112 Homestead
Valuation or 535.000
Signature of Auditor I Date signed