HomeMy WebLinkAboutHomestead_Miller (3)CLAWFOR HOMESTEAD PROPERTY TAX FORMJ YEAR
CREDIT/STANDARD DEDUCTION HC10
State Forri 5473 (R614-M) I I
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: Sq"verse side for riling instructions.
-IATIATEMENTi'n.-I:.,E 'F
I (We) 4A W A.,' U— / 7 7 CRW--�
certify that on the I at day of March, 20
I (We) occupied as our princal place of residence the following described real property for which a Homestead Proper4b"rickospm claimed:
❑ I (We) owned ❑ Are buying under contract
Dave a beneficial interest in the entity that is (table for the property taxes on the property and that owns the property a ,bur*i %* a contract.
If buying on contract, Fee Simple owners name
contract is recorded
A
Record number [Page
�S'W-';020t- , �"W' PRC)PEATY,'OME15�(3*,CL!AJMA�NT-,IN'OTHER-COUNTIES"�,�,
--e— @�t'v ':.� -, - 1, " - �' - - - -'-- -- - -- --
PRO PE RT,* DESC FCIPTIO N
County
Township
Timing district (city, to", township)
kAXL
County
16TV-5
IZ)n 9 7 1
Legal description
a grope In
N�eal property ❑ Mobile Home (I.C, 6-1.1-7) U
If any portion of the residential structure or the land not exceeding we (1) am that immediately surrounds that stn- is used to produce income, describe the use and portion
of the property utilized to produce income.
�S'W-';020t- , �"W' PRC)PEATY,'OME15�(3*,CL!AJMA�NT-,IN'OTHER-COUNTIES"�,�,
20 Pay 20 _
'b"H'd MES . TEAD'�'
County Township
County
6,01
Township
I hereby certify the above statements are true, correct and complete.
Signs
aimant
F
-Wnumber aid street dry, s1jt ZIP code)
Land not exceeding 1 (one) acre immediately
C ;+
surrounding residential improvements.
/ t
qw-%
OR 0 - "Na
USE L
20 Pay 20 _
'b"H'd MES . TEAD'�'
F--YV-'�t - N 6N-RESl DENTIjkL-'�--P-§V,
St
W-0 ejV,1
6,01
PRV
,7 .
_
Slffof it
Land not exceeding 1 (one) acre immediately
Date sigo& 40 -0!�
surrounding residential improvements.
'.e
Other land
(2)
j t�
Total land (line I plus line 2)
(3)
-P, A' -
Residential improvements or Annually
Dwelling
(4)
Assessed Mobile I Manufactured Home
Garage
(5)
kx
improvements
(6)
1- T - A
.9�er
Total Improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
VenfftV action - Signature of Auditor
Date signed
STANDARD DEDUCTIOWALLOWANCE-,
20 Pay 20 _
Lesser of 112 Homestead
Valuation or 535,000
Slffof it
Date sigo& 40 -0!�