HomeMy WebLinkAboutHomestead_Phillips (11)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
I (We) Q�o.iu►'+na. C)M C `i,T KAM
I (We) occupied as our principal place of residence the following described
❑ I (We) owned ❑ Are buying under contract
FORM nYEAR
HC10
certify thal!tt� pp`r��1!thi%l I d &IMarch, 20_
property for which a Homestead Property Tax Credit is hereby claimed:
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
0 NTRACPRECORDED_rs
If buying on contract. Fee Supple owners name
Recorders office where contract is recorded Record number Page
�.v%�.���?rsl 3� �lr' �•;=, iP .ROP,ERTY<BESCRIPTION.'ir..�_3 .'`I,._�,`7•,'''- r',.`` x � �° fft�t•"�'R`,�_g�.s ='*_. a,T?.s_ >_;s
County
Township
Taxing district (cl , own, tow hip)
Rarcel number
IOa-
Legal description
-Lnu 14
sn
the—property
.61
-a -g
Real property ❑ A1a 'e Home (/.0.67.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. r QC-4q
PROP.ERTY.OWNED`BV CLAIM,ANTiN: OTHER 'COUN'fIES'+`r�`�'````'-_�,
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County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant 4 do
-dress (number and street, city, state, ZIP code) _
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A ESuSOR US ONLY "' -
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AAT100
°S9'H.�VALUEEADR
ti N, L
t.
VALUE +�3`�,iac
%OF,T. V
VALUE.''
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land_
(2)
.,`- ter,` -�"`
.�3V3�itD
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
sy9
a-All-
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
_
Other improvements
(6)
eµ, -j'y>
ON
Total Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
TANDAR
SUMEDUCTION ALLOWANCE
_ ......+r- >u';�43i� -�s'..�e. ',a+•_•"�x'.a�,+�: _,:rs�.rtYai `�.k^ -' s`.,y'4'�,.
20_Pay 20_
Lesser of 112 Homestead
S
Valuation or 535.000
Signature of Auditor Date signed