Homestead_SamsE7
7
CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R61 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10
n
I (We) certify that on the 1 st day of March, 20=
I (We) occupied as our principal place of residence the following des bed real property for which a Homestead,Qroperty Taz.Credidit is hereby claimed:
(We) owned ❑ Are buying under contract
hi 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.
esyM�'; -i}k aCONTRACTRECORDE05a._'�XY' --t'
--
If buying on contact. Fee Simple owner's name
Recorders office where contact is recorded Record number Page
= ;•t:¢'� .srr� nay M '3
County
County
Township
Taring district (city, town, township)
Parcel number
Legal descripliW' _ ,.., „/I
�LA��Y i(16jllVfl)�.
Is the property in question:
eal property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding dub (1) acte Nat immediatety surrounds that stn re I$ used to produce income, describe the use and portion
of the property utilized to produce income.
?3`+r a',3e=AW-MW»-.-` �`' ee�. fPROP .ERTY,OWNEDBY'CIAIMANT -IN.' OTHER' COUNTIES; f` �. �„ �' y��'. `--.,'��y„'�.��`^'s�c�•t" ->-v
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of cl 'mart
Address (number and street, city, state, ZIP e) DU O
+qa^s`
ASSESSORUSE ONLY. "
A '1 �� :a.+r '%�r'�Ft.�r •.�
TRUE TAX
ryALUE"
'��...-
ASBESSED,VALUEHOMESTEADi��r'
"AT.i700 %',OFTN
�.,a.�..,:1
VALUES
' #NON- RESfDENTU\L
t, -VALUE
�ae�irt,�:'1: -. ,,.w..
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)SIMMER
Total land (line 1 plus line 2)
(3)
Residential Improvements or Annually'"
Assessed Mobile / MerarfaLbrrred Hone
Dwelling
Garage
(4)
t
��
'fir
Other improvements
(6)
'q- yam• ="�-p)
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 jolts line 7)
(6)
hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
-'�.- STANDARD_ DEDUCTIONALLOWANCEtJ`,.
20 _ Pay 20 _
Lesser of 112 Homestead
S -
Vewatton of S35.0o0
Signature of Auditor Date signed
't ' l-