Homestead_Rodriguezrtq
t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
J State Forth 5473 (R5I 1"I)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) I AALIM Y A y%k J T\
I (We) occupied as our principal place of residence the
❑ I (We) owned ❑ Are buying under contract
FORM
1A YEAR
HC10 `"\�
certify that on the 1 st day of March, 20
real property for which a Homestead Property Tax Credit is hereby claimed:
a beneficial interest in the entity that is liable for the property taxes on the property and
a contract.
_.'"•'-.r. t" sz`c'::_- ec'',3' - �'..._ b'` ...t'> a.� � ." 'iS:rt`�CONTRACT.REC --- - .r zi :+"'i'C?% s°dn.YY— ..' -':',t a' :_ i'`'"k'•i_.:: i#. `�`' MY If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Re numb Page
ITV t iTn
`G`',`+.`.,'.. sot- r,' wXIz.'-}* o-K#" 7as's- >v: ?PROPERT.Y.OESCRIPTION
County
Township
Taring district (city, town, township)
P rce
6
tuber
Legal cnptt
3
Is the property in question:
❑ Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential sWCturo w the land not exceeding one (1) ave that immediatety wrtounds That structure is used to produce income, describe the use and portion
of the property utilaed to produce income.
rN? `PROP.EATXbWNED BY CLAIMANT; IN' 6THER -000NTIES',ri`'t,�,.z
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Si
re of cl imam
U
A's (number and street, city, state, ZIP code) '
3
ASSESSOR USE ONLY �"+
...�ae'�.'
r TRUE TAX S
ASSESSEDVALUE
S PHOMESTEAD� `'ffl�NNON=RESIDENTIALI
wVALUE :!IAT.1000%.OF
TTV.
tea- `_.VALUE r��1
#,aY .VALUE+ai r�k
Land not exceeding 1 (one) acre immediately
(1)
If
it,
surrounding residential improvements.
u�-
_
Other land
()
"- -""� 4.:.
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
5
()
IS,
m a x
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 phs line 7)
(6)
hereby certify the above is We, correct. and
Signature of Assessor
Date signed
complete.
Verifying action - Signature ofrwditor
Date signed
20_Pay 20_
Lesser of 1/2 Homestead
Valuation or $6,000
Date signed