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CLAIM FOR HOMESTEAD PROPERTY TAX �Q� FORM YEAR
1 CREDIT /STANDARD DEDUCTION HC10
Stale Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (Wef� \ N(LV�, T `J certify that on the lstu bf MerGch,
,I�(We) upied as our principa place of residence the following described real property for which a Homestead Property T Credit is herebyC
-FSI (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 ls�ppgQ l i
h <CONTRACTRECORDEDr
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
3..P.ROP.ERTY,DESCRIP,TI01 •..ms`s °..'_c._.x'e�?a'
*.?..�'>
County
Township
NONRESIDENTIAL
91'
Testing distri city, o t w 1
ALUEzm
I r 7
0 0 1 ' 0
Le escrip' n
"dress (number and street, city; state, ZIP code)
/0 • A". Co /N---n tq 7A
property iinn question :
�ycneal Drop
❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or thdriand not exceeding one (1) acr
of the property utilized to produce income.
t immediately surrounds that structure is used to produce income, describe the use and portion
.: 4:x:�.,. i-:rC - -. .^r7cov?:.'`,PROP.ERTY;OWNED.BY CL'AIMANT:IN:OTHER "COUNTIESp "4-, =-
Tye - a��t -xi "'... « T - ... .. _ _ -- .._.. _ _ _ afi,��eu r , Sr „.e e
County
Township
County
NONRESIDENTIAL
91'
ALUEzm
I hereby certify the above statements are true, correct and complete.
Signa r I c
"dress (number and street, city; state, ZIP code)
/0 • A". Co /N---n tq 7A
^�'i r'ASSESSOR USE ONLY ' y -i'+”` is
i, TRUETAXri-
I
ASSESSED VALUE
�Y-HOMESTEADt{`
NONRESIDENTIAL
91'
ALUEzm
n119 0 %OF TfV
e`� VALUE
lk �VEc�i
Land not exceeding 1 (one) acre immediately
''`_•�� "`y�.y0.
surrounding residential improvements.
Other land
(2)
OF
Total land (line I plus line 2)
(3)
Dwelling
(q)
���
Residential improvements or Annually
Assessed Mobile I Manufactured Hoare
Garage
(6)
`'' _
� r• '' � c
:.
Other improvements
(6)S
{ =-
r�?
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
`>, ��-, 'ya1T.`7vIC'STANDARD'.DEDUCTION ALLOWANCE'??r„7','cW"",.,p'�-
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation o1
Signature of Auditor Dat