HomeMy WebLinkAboutHomestead_RobersonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDMSTANDARD DEDUCTION
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State Form 5173 (RS 11-03)
Prescribed by the Depenmem of Local Govemment Finanoe
INSTRUCTIONS: See retartea Ads for fift ita6uetiorro.
RTIFICATION STATEMENT ^,
I (We) V .l._/ certify that on the 1sLday oLA'arch, 20
I Me) occupied as our cipal place of residence the following described real property for which a Homestead Property Tar AUDITOR Credl is hereby claimed:
�trsaON COUNTY
❑ I (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.
' NTRACT. RECORDEDF '�s�.`-""u- �y"',d?i''`t;«'��"�r -sue
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
'r'ers- tist�"„psi,'PR0P,ERT•Y DESCRIPTI6N'" �i?.`'- ;,';rs','''"3.,`-z?>�,'"tr.�',
County
S
Township
Taring t (G town, township)
.VWP II /ry_utuber `��7,, 9
-006W -006 /
L I descri IT
is the ro rty L question:
Real property ❑ Mobile Homo (I.C. 6-1.1 -7)
If any portion of the residential structure or the Land not exceeding one (iloe that
of the property util¢ed to produce income. / ty sunounds that sidcture is used to produce income. describe the use and portion
Date signed
ROP.E RTY,OwWItcF Y cbi MA Wt LNOTHER" COUNTIES. ?- ..- r4,�Tsa
County nship
County Township
I hereby certify the above statements are We, correct and complete.
Signature laimant
Address (number and street, city, st e, IP code)
�' �• `)` '" ' ' se •'TRUE
ASSESSOR USE ONLY.:,; 'r
TAX I-
ASSESSEDVALUE
.r
-,2; MESTEAD
"7A,VALUE�
NON 2ESIDENTIAL
vatuamn or E35.000
'u'VA_L_UE:
AT�100 %,OFRT- TVA.,_-
Date signed
Land not exceeding 1 (one) acre immediately
mf` ° �'',+,- c�}•�;
�"
surrounding residential improvements.
f
O
• �'"°'' 'r r
Other land
(2)
}`-
to
Total land (line 1 plus line 2)
(3)
'
Dwelling
(4)
(� 7W xd
-'1 aErtr� "`
'Residential improvements or Annually
Assessed Mobile / Manu(atdvred Home
Garage
(5)
Other improvements
(6)
Tctal improvements (line 4 through line 6)
(7)
pal value (line 3 plus line 7)
(6)
reby certify the above is W e, correct, and
Signature of Assessor
Date signed
mplete.
FIN
tying action - Signature of Auditor
Date signed
•.' a_�' ' `�5,._. s ''"` ,v -`,ST/WDARDMEDUCTION'ALCOWANCE z.;ro �' eS` -'a.; "'.r`%t€'•:�'`'x`3._+:�r'' '�-'�� ' 3 ri
20_Pay 20_
Lesser of V2 Homestead
TS
vatuamn or E35.000
Signature of Auditor
Date signed