Homestead_PitcherCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling insirtxbons.
I (We) _.t/�.� W �+ hdt ke
fy t e 1st day of March, 20_
I (We) occupied as our principal place residence the f'
ollowing described real property for which a Homestead Prop_e(( i tt V CTdtMereby claimed:
El l(We)owned El Are buying under contract .MA7
Have a beneficial interest in the enfity that is liable for the property taxes on the property and that owns the property-pr is buyin"Tider a contract.
If buying on contract, Fee Simple owner's name
Recordees office where contract is
Record number I Page
- — _ .
r �-� �.,fyV. a - `tom M.._- i=' .+.RI h }
;- -'<"' r' - e.. ..,r�1<'— rte. �^rs'�'�s�.?�_. -: w'�- .�P,ROP,ERT,Y:DESCRIPT1bN.: �. -,��: •�Sf:- i'r'.��,.V. ..' .zr''�u�•.��,?i<'�;T.:>
County
Township
Taxing district (city, town, township)
Pa 1
number
D❑
Lea e ' ton Is the property in question:
Real Property ❑ Mobile Homo (I.C.
I any portion of the residential structure or the lind not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utiiuM to produce income.
County
Township
hereby certify the above statements are true, correct and complete.
(number andj�,4et, city, state, ZIP code)
s - `F �ytir .- '
°.£ ASSESSOR USE ONLY
7! eta
g.TRUE TAX tr..
ASSESSED VALUE
HOMESTEAD ��
Y NON = RESIDENTIAL
,:
xVALUE_TS
AT�10o %.OF ;TTVrt
.'4d�.r- VALUE�e
fig
C.*r�L'i- oV/LLUEr'..a'
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
"via -
(2)
Total land (line 1 plus line 2)
(3)
(Residential
Dwelling
(4)
^..-.r,.
SON'... ��'��'�
improvements or Annually
�
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
R: t
RA
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(g)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed