HomeMy WebLinkAboutHomestead_PirkleCLAIM FOR HOMESTEAD PROPERTY TAX �ORM-- YEAR
CREDIT /STANDARD DEDUCTION CIO
State Form 5473 IRS 110-01) FVT I afn
re Prescribed
by the Department of Local Dmernmetrit Finance
INSTRUCTIONS: See reverse side for filing instructions. FEB 9 1 2003
I (we) (—X CttA(� 7� ZA AZ Z 4--) *a MWch,120 —
I (We) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Ave buying under contract
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.
WrRACTj'RECORDED-
If buying an contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
I M�Zrr
20'4� 6 i .
County Township
County Township
1 hereby certify the above statements are true, correct and complete.
.
isl to", 0
atur a* ant
W (number r ZIP n
17 4) —
q7660
rT Zq,� Wthip)
n;(
Par I nu bar
Legal descriptb
Is the property in question:
'ZROW
property ❑ Mobile Home (I.C. 61. 1-7).
If any portion of the residential structure or the land not exceeding we
—A—�]
Wacre that immediately surrounds that structure is used to produce Income, describe the use and portion
of the property utiliz to produce income.
Residential improvements
I M�Zrr
20'4� 6 i .
County Township
County Township
1 hereby certify the above statements are true, correct and complete.
ig
atur a* ant
W (number r ZIP n
17 4) —
q7660
0
Zyp- A ,y'
ORMPH-A—Ilt-ANN, M
ESWR,USt;ON L
1— W-111471t
20'4� 6 i .
Ss laffiD006E
-
HOMES!OEly
N-0QrE—S1DEtaVW- Q'
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
V0
Other land
(2)
Total land (fine I plus line 2)
(3)
Residential improvements
Dwelling
(4)
Garage
(5)
- t5
R
Other improvements
(6)
"KAN
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above Is true, connect, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
UMSTANdARD7DEDUCTtON"ALILQWANCE'+���
20 _ Pay 20
Lasser of 1/2 Homestead
Valuation or $6.000 $
Signature of Auditor Date signed