Homestead_SaulmonCLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
7z -. a f-"" " :.-5fRTIFICATION STATEMENT. APR 0 5 2002
I (We) certify ton the is & Me ch 0
0 'ch 0
1 (We) occupied as our principal place of residence the following described real property for which a Homestead r Xe tf��9' h6f,40A�Ijd
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GIB Sot4 C I
(We) owned ❑ Are buying under contract certify ton
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;lave 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.
' -CONT RACT ' R ECO R D ED
If buying on contract. Fee Simple owner's name
Recorders office where contract is recorded Record number Page
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P RO P E RTY. 0 E SC Rl P70N', .
County
Township
County
township)
/'5'-0D
Legal description
ffss (number street city, state ZIP code)
I S � ,'A -r' 's r
is Eetrty in estion
W-I property ❑ Mobile HMO (I.C. 61.1 -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.
PRIDREIMblINNED B'if C"IM414T IN OTHEW11COLINtIES ti
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County
Tmnship
County
Township
I hereby certify the above statements are true, correct and complete.
S417 we
ffss (number street city, state ZIP code)
I S � ,'A -r' 's r
41
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MAW
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ASSESgg&��LU-E
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HOMESTEADS
�NOWRESIDENTIAL.,"�'
BASSESSOWUSE ONLY4;;-.;x
-VALUE;,
F,T TV
'-"VALUEV
41
Date signed
I
Land not exceeding I (one) acre immediately
surrounding residential improvements.
L
Other land
(2)
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
Mc—
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 pits line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 Pay 20
Lesser of V2 Homestead
$
Valuation or $6,000
Signature of Auditor
Date signed
I