Homestead_SmithCLAIM FOR HOMESTEAD PROPERTY TAX v� FORMR
CREDIT/STANDARD DEDUCTION e HC10
State Form 5473 (R71 • i�
P:esuibed by the Department of Local Covenunax Flranoe r TD
INSTRUCTIONS: See reverse side for filing instructions. lyp)
I Me) /dJ//)�%%J� r1 �/YnrT� - -- - - - - certify thag L2 std ay of March, 20
I (We) occupied as our principal place d residence the fonovAng described real property for which a Homestead Property Tax Cre�i t j; hereby claimed:
I (We) owned ❑ Are buying under contract // , ' �y(�y���
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns thuwwo firing ttt(QerTaOLtracL
CONTRACT RECORDED Z • - .. .
If buying on mntracl, Fee Simple canals name
Recorders office whera contract is receded Record number Page
...PROPERTY OWNED BY CLAIMANT Di OTHER COUNTTPS �
PROPERTY: DESCRIPTION
County
Tatum -tip
Township
Taxig district . town, townsho)Y
ne of dairtaN
(nanber and street mify, 3ats, ZIP ocde)
: -' VALUE
1
Parcel number �,n
Legal desorption
Is the property it pueston:
/ to - 003 7 - c 6
surrounding residential improvements.
(1)
rkteal property Mobile Home (I.C. 61.1 -7)
If erry portion of the residential structure or the lard not exceeding one
(1) acre that inmadately surrauds dud strmictxe is used to produce income. describe the mere and portion
of dy ublized to prock. inns.
(2)
-
aG 141 19- -I %ab
Tdal land (lire 1 plus fire 2)
...PROPERTY OWNED BY CLAIMANT Di OTHER COUNTTPS �
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
ne of dairtaN
(nanber and street mify, 3ats, ZIP ocde)
r t ?
:ASSESSOR USE ONLY -
;rr TRUE.TAX
ASS VALUE
HOYFSTFJID
r NONiiES1DENTULL �•.,
r _
VALUE: m -
AT.700X :QF TTV.n
: -' VALUE
Land not exceeding 1 (one) ave immediately
'
surrounding residential improvements.
(1)
Other lard
(2)
-
Tdal land (lire 1 plus fire 2)
(3)
Dwelling
(4)
r, .
Residential improvements or Annually
-
Assessed Mobile / htanufact red Hone
Garage
(5)
>
Other improvements
1(6)'
:'F °' tti:: •I
Trial improvements (fine 4 through fine 6)
Trial value (line 3 phs line 7)
(g)
_
I hereby certify the above is true, cared, and
I Signature of Assessor
Date srgmed
complete.
Vailying action SgiaNe of Atddar -.._— .— —
Dar siymwd
20_Pay 20_
Lesser of 12 Homestead
Valuation or 535.000
SgaaxB of Amdimr
5