Homestead_McDowellCLAIM FOR HOMESTEAD PROPERTY TAX
CREDMSTANDARD DEDUCTION
State Form 5473 (R7I 5-0%
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side Ior filing instructions.
FORM
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I (We) Lbtkxn I- _cerf-rfy ton the 1st day of March, 20_
I (We) occupied as our principal place of residence the lollowAng described real property for whxh—jlj p Tax Credit is hereby claimed:
w
I (W%) owned El Are buying under contract GIB5014 COUNTY AUDITOR
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract
RECORDED
COI �CT
R buying on conbact Fee Simple owner's name
Reconfees attics wherv, contract w recorded Record nmbw Page
PROPERTY DESCRIPTION,
County
Thip
County
Tatung d" (c#y toonstw
0 dc(V
and Motor
Legal description
e property
Is the in question:
, ,
740-00/ )
1 ❑ Real moneat. �'le llon (LC. 61.1 -7)
Marry potion at struLre ar fM tact Mal exceeding one (1) am that wieneclialety surrounds flvd strixturr, is used to prod" income. describe the use and portion
d the property LdjfLzBd to produce ancorne.
0 a.
:PROPERTY OWNED SYCLAVIIIANT IN OTHER COUNTIES 4..
County
Township
County
Township
I hereby certify the above slabaments are true, correct and complete-
SUrtature of claimart
CL A& IJ
shb,pss end sleet. city X Zw
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4- VJUJJE"�"�
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'.,i ASSESSOR USE '6ky
TfiiJE.iAX'
ASSESSEDVALUE
Lesser of 12 Homestead
40
$
AT-100%OV
4- VJUJJE"�"�
'4
4
1', -"11,
Land not exceeding 1 (one) am immediately
surrounding residential improvements.
NZ
O&w land
(2)
TctEd land ( /tire I plus lboo 2)
(3)
Dwelling
(4)
ResidentialimprovementsorAnnually
Assessed Mobile I Manufactured Home
Garage
-z a...
i
(5)
Other improvements
(6)
Tdal improvements (fine 4 through Im 6)
(7)
Total value (Arre 3 plus fine 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete
Voifying action - Sigrature of Auchor
D-rW signed
STANDARD DEDUCTION ALLOWANCE,
20 — Pay 20
Lesser of 12 Homestead
$
Valuation or f36,000
sgnatura of AIKUW
MQA4k
Dale so
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