Homestead_ThompsonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R4I &00)
INSTRUCTIONS: See reverse side for filing instructions.
I (We) VwW certify that on the tat day of March, 20_
(we )ed as our principal place of re ence the following described real prop rty for which a Homestead Property Tar Credit is hereby claimed:
FORM YEAR
HC10
(We) owned ❑ Are buying under contract -71 a IT TT"
tave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prop or is � under a
If buying on contract Fee Simple owners name
c �y/ / l n /1
Recorders office where contract is recorded CI36rC±i Cp(,J;j AUDII-OR
e�
.�3�ria��,'r,m_ -.'�,i
'!S'."_y�.� >s~�:a i4, P,RQPERT'�pESC_RIP�T.I - ' �rr. �" �ai'r'';'��r�S�,aG',.,T.�`� >':. •n
County
Township Twing d c
, fo+wn tow shi
n mbar
egal description
If any portion oo the re sidential 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 properly utilized to produce income. -
'. r ` �STANDARD.'DEDUCTI_ON;ALLOWAMCE
County - Township
County -
Township
$
uation or 56,000
I hereby certify the above statements are true, correct and complete.
Sig ture of claimant
Address (number and street cd): state, IPcode) -'
t✓ 4y 6 6
- ai - yA�S�SE.SS�O`R USEON�hy"p
�a:VALUEex+.ATt?
ASSESSEDeVALUE
700 %OsFtTrN,y;�VAI9UEI�`��VALUE..•
"�aMOMESTEAD�
NON ESIgENTWU.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
2
_'•i}},,
V- ris NES
Trial land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
r
y.
Garage
(5)
_
1-'r ,'M '; `e•
ROOM l-11'1 , Y
Other improvements
(6)
y�.r��s
LNLav!Y �"'•.
K�'+rr' � '
Total improvements (line 4 through line b)
(7)
Total value (fine 3 Plus fie 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature or Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
'. r ` �STANDARD.'DEDUCTI_ON;ALLOWAMCE
20 _ Pay 20
Lesser of 12 Homestead
$
uation or 56,000
Signature of Auditor
Date inert