HomeMy WebLinkAboutHomestead_SteberCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION
State Forth 5473 (R51 10-01) kiclo
Prescribed by the Department of Local Government Finance _LL
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-ICERTIFICATICIN STATEMENT
e- hek certify 'at� day,of March, 20
1 (We) xe
P.LFLIM."I
I (We) occupied as our principal place ofresidence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ 1.(We) owned ❑ Are buying under contract
0 bve 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.
r C 0 NT RA CT 2 R E C 0 R D E D 11
If buying W contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
.4-;' jkMt*W P, ROP E RtY,.E5ESCRIP.Tl1C1Wr2F -iM 3(4
County
kskSS'6-.VALILIE
11VO
I Taxing disr;� row =�t C-
Paroonumber
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Legal description Is the property in question
I ER-<.1 property ❑ Mobile Home (I.C. 6-1.1-7)
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.
AT F X
County
Tmnship
County Township
I hereby certify the above statements are true, correct and complete.
Signaft of Qlaimant
(number
,and 4 street, city, sIZr c �
j
r . p - 4,.
C,
dr- ASSESSOR USE ONLYc r
k' TRUETA;0�—
kskSS'6-.VALILIE
11VO
;F
HOMESTEAD`
W NON = RESIDENTIAL
z
'.^
VALUE
AT F X
3
Land not exceeding I (one) acre immediately
p
surrounding residential improvements.
Other land
P7 -Y.�eg
(2)
Total land (line I plus line 2)
(3)
pct 'I
A An
M
Dwelling
(4)
R
Residential improvements
�Vrkj
Garage
(5)
A
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
1(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TANDARV.DEDUCTION�ALLOWANCE-��'-'!?,V,�,�."
20 _ Pay 20
sser of 1/2 Homestead
Val $ n or $6,000 T
Signature of Auditor D to si ned