HomeMy WebLinkAboutHomestead_Richardson (3)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 filing inslmctions.
FORM YEAR
HC10
I (We) certify that on the 1 st day of Mardi, 20
(We) occupied as our principal place of residence the following described real property for which a He e�stead Property Tax Credit is�firtreby claimed:
IYi cif
❑ I (We) owned ❑ Are buying under contract GIBS Ord �,,-,; AUCIT'
Ph 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.
�-3k.- ups#' �..= �t�;-,.` s�' �:' �` �`" �''`�+.-.•y,,'�'3.y�rCONTRACT' RECORDED ,,rxx"�'�3ca- �r�£1,•'���'`�= aF�"a;� �"'�'' �- ^."1'arw'
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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r -'.r ASSESSORUSE �NLY
County Township
ROPERTY :OESCRIP.TION'st.i_.�.,..ds�°r
-
County
Township
Address (number and street, city, state, ZIP code)
�t
Tatting district (cittlown, township)~- ^
l/
Parcel number
0/1'-00939-146
Legal description
Is the pro i uestion:
Real property ❑ Mo I Home (I.C. 6-1.1 -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.
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r -'.r ASSESSORUSE �NLY
County Township
County Township
hereby certify the above statements are true, correct and complete.
Si ure
Address (number and street, city, state, ZIP code)
�t
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r -'.r ASSESSORUSE �NLY
(TRUE TAXI ¢
-.
ASSESSED VALUE
HOMESTEAD
'' N RESIOENiIAI
ia'.,� +. <xrr�� -,r '"'s",g�
i1 VAIUEX'9
AT 100 %'OFTTVA
YVALUE=
�,� M.a-
Land not exceeding 1 (one) acre immediately
valuation or 535.000
t of Nrdpor J
surrounding residential improvements.
Date signed
K f /!//
Other land
(2)
fE = sr
ONN NO
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
- y��.;
Residential Improvements or Annually
..�`'It�fiiS
Assessed Mobile / Manufactured Horne a
(5 )
+
�`_�:•
Other improvements
(6)t
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, coned, and
Signature of Assessor
Date signed
complete.
Vailying action - Signature of Awditor
Date signed
.
j�'�),r<';` .-� +', STANDARD _:DEDUCTION'ALCOWAHCE?rf�'q
2QnL Pay 20 /
Lesser of 112 Homestead
$
valuation or 535.000
t of Nrdpor J
Date signed
K f /!//
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