HomeMy WebLinkAboutHomestead_MastersCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HCto
♦ - State Form 5473 (R5I 10-01)
Prescribed
by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We certif){Woaha INQ of March, 20
I,(W/e) occupied as our ncipal pla of resid ce the following described real property for which a Homestead Property Tau Credit is hereby claimed:
EJ I (We) owned ❑ ke buying under contract
Have a beneficial interest in the entity that is liable for the property takes on the property and that - usJt op l lls uyf�sg- iyu(�rrW- cer�{a' contract.
NTRACTRECOR _DED..'- f.n-- -`"'s'4',a,'�c
If buying on contract, Fee Simple ownees name
Recorder's office where contract is recorded Record number Page
-a._
P,ROPERTY dES d RfMION
W" y, 1
County
7uvnship
Tmnship
Taw is
'ct ( o ship)
:VALUE
VAI:UE..X
e
Legal d don
I hereby certify the above statements are We, correct and complete.
Is the property in
sawn:
f, city; # Z code)
surrounding residential improvements.
❑ R
property ❑ Mobile Homo (I.C. 6-1. 1-7)
If any portion of the residential structure or the land not exomcK one (Ib
acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property util¢ed to produce income.
1_ r U
y ` i x" x''
53ESSOR�USE ONLY
TRUEaTAX
' "
ASSESSED VALUE
°A'citz"MY�
County
a '' NON RESIDENTIAL A
`M¢
Tmnship
County Township
AT1t00
:VALUE
VAI:UE..X
Land not exceeding 1 (one) acre immediately
I hereby certify the above statements are We, correct and complete.
Signor re o ctaimant
d re umber ad
f, city; # Z code)
surrounding residential improvements.
1_ r U
y ` i x" x''
53ESSOR�USE ONLY
TRUEaTAX
' "
ASSESSED VALUE
°A'citz"MY�
'HOMESTEAD`
a '' NON RESIDENTIAL A
`M¢
r4
VALUE,, ,
AT1t00
:VALUE
VAI:UE..X
Land not exceeding 1 (one) acre immediately
s m
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
_R ♦ F C X
=s
#4
&u°,.�",icr
Residential improvements,4r-
Garage
(5)
Other improvements
(6);`
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed