HomeMy WebLinkAboutHomestead_PiperCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R6 I4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
Li
J FOHC10-� RM YEAR
JUN 2 1 2006
I (We)_ / �� -� (y- ��/�,�n) - GBSOM COUNTY AUDITOR
�ZPd1? certify that on the 1st day of March, 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby daimed:
(We) owned ❑ Are buying under contract
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.
s-
sCONTR.4CT.' RECORDED' �- a' � "#w':�'?i'h'3Fi- �-'�.rx�''��e�t
If buying an contact, Fee Simple owners name
Recorders office where contract is recorded Record number Page
ki%Z ?ROP.ERTY,OWNED;BY CeAIMANT WIDTHER"COUNTIES
County
Township
Toeing district (city, town, township)
Parcel number
des on
P -
Is the props in question:
sal property ❑ Mobile Home (/.C. 6-1.1 -7)
If any portion of the resitlendal structure or the land not exce g one 1) acne that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
/
-414d-A ct - -1.3 -ay. Gtr
ki%Z ?ROP.ERTY,OWNED;BY CeAIMANT WIDTHER"COUNTIES
County Township
County Township
hereby certify the above statements are We, correct and complete.
Si atu o daimant
Address (number and street, city, state, ZIP code)
- t�'SASSESSOR USE ONLY `r lx
`*TRUE TAX'�'yx
ASSESSED VALUE
HOMESTEAD
i�:^`VALUE<i.....-
NON - RESIDENTI AL
Land not exceeding 1 (one) acre immediately
S
surrounding residential improvements.
vauanon or 535,000
Signature of Auditor
Other land
Date signed
Trial land (line 1 plus line 2)
(3)
Dwelling
(4).•
y .r -- ,
'Residential improvements or Annually•
�g�%^ -fir-
Assessed Mobile / Manufactured Home
Garage
(5),,
�*
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
M02 z'e�f, ` STANDARD: DEDUCTION ',AL'LOWAHCE,_??
20 _ Pay 20
Lesser of 112 Homestead
S
vauanon or 535,000
Signature of Auditor
Date signed