Homestead_Tooley (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
t CREDIT /STANDARD DEDUCTION
State Form 5473 (8817 -07)
H. f Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
(We) n a" �—J certify that i March, 20_
I (We) occupied as our principal place of residence the following described real p rty for which a Hcmestea T redit i eby claimed:
�'� COUNTY AUDITOR
bk>qWe) owned ❑ Are buying under contract
PF Have 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.
It buying on contract, Fee Simple owners name
Recorders office where contract is recorded I Record number I Page
County I Township I Taxing district
Parcel number Legal escri tin Is the property in question:
- - I property El Moble Home (lc ti- 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.
a�0 -/(f 9) - a 7
County
Township
County
e of cl t
'moo
I hereby certify the above statements are true, correct and complete. \' Signatur /�i
W5(nf 3qd - c.- C Soo' Si O '/_A-tif% (f 7rt -"i 7-161,
20_ pay 20_
Lesser of 12
Homestead Valuation
or
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012 $
43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor A y / I Date signed (month, day, year)
Land not exceeding 1 (one) acre immediately
-
surroundingresidentialimprovements.
Other land
(2)
-
Total land (line 1 plus line 2)
(3)
ResidentialimprovementsorAnnually
Dwelling
(4)
-
- -3 -.
Assessed Mobile I Manufactured Home
Garage
9
(5)
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day. year)
complete.
Vsifying action - Signature of Auditor
Date signed (month, day, year)
20_ pay 20_
Lesser of 12
Homestead Valuation
or
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012 $
43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor A y / I Date signed (month, day, year)