Homestead_PeayYEAR
CLAIM FOR HOMESTEAD PROPERTY TAX FORM M CREDIT /STANDARD DEDUCTION
State Form 5473 (R5110 -01)
Prescribed by the Department of Local Government Finance -7
feu INSTRUCTIONS: See reverse side for filing instructions. 1�1
CERTIFICAT10N STATEMENT'..
0z
I (We) AP lifythatonthe 1st day ofMarch, 20
al which Homestead to
I (We) occupi as our prinGal place of residence the owing described real property for which Homestead rope Tax Cr ' it i efeby claimed
'ccup? ❑ buying under contract
'0❑ I (We) o ad Are AI)DITOR
1ave a beneficial interest in the entity that is liable for the property taxes on the property a 96FAAGlt� erty or is buying under a contract.
F % • lx�- Wi;0` 2, ieZk�% CONTRACT!RECORDED;",,'ir--, -"V-
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
County
Township
Taxing district (city, town, township)
lh�iperty in question:
❑ Real Property ❑ Mobile Homo (I.C. 61.7-7)
If any portion of the residential structure or the land not exceeding one (1) a e that immediately surrounds thats"chire is used 0 produce income, describe the use and portion
of the property utilized to produce income.
01�-M301:�K
��T �r-PROPERIY
?,- - %:-.- -- - - -- 6WNEd BY CLAIM4NT IN CITHEWCOUNTIES
4 % -)�.- -eft.
.
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Van of claimant
,�;,�rty state, � code)
WeVumbe
0 X C;1� A - M a
01A a�L
WUSEONLY�-Z-'iT-1 --T-a,
JRUE7TAX
ASSESSED VALUE
t;AT
Z-HOMESTEAD-
jk: -NCIWRESIDENTIAL-
-'t� -`O`hVALUE�`�-'--
ij - " ;-r — -
. . . . . . . . . . W
- -,',
100 OF�TTVI
VALUE'
'3
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
�it rL,
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
20_ Pay 2O_
Lesser of 1/2 Homestead $
Valuation or $6.000
Signature of Auditor LJ Date 4'-