HomeMy WebLinkAboutHomestead_VanwayCLAIM FOR HOMESTEAD PROPERTY TAX `1(J FORM
YEAR
CREDIT /STANDARD DEDUCTION D Hc�o
State Form 5473 (861403)
Prescribed by the DepeNrrom of Local Government Finance
INSTRUCTIONS: Sae reYarao dda for Chill inabttcdom �(
I (We) ( �1L/ 7�• 1\ � � y Q/y\ t�J Q.l,.`� aW t on ��`Y'st day of March, 20_
I (We) occupied as our principal place of residence the following described real property Qwhich a Homestead Property Tax Credit is hereby claimed:
i
❑ I (We) owned ❑ Are buying under contrail � �
Have a beneficial interest in the entity that is liable for the property taxes on the property and thtMM ttiey[aq�Tj>,'oi4clb�t � under a contrail.
'� -mss ONTRACTRECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
` r. aF2 4"^ e rg`x'a "" ,. �aP .ROP,ERTY.DESCRIPTIONr: &'���3a_ c:, ,E( - .'_'_"`. .-£a "+.- f r.?�2T`'s }aa`s?n` -'..�,
County Tavnship
Taring district (city, town, township)
ceJ Unbar �/ D Le de n
/V_ �
party in question:
8
t1 (
❑ Real property ❑ Mobile Home (I.C. 8. 1.1 -7)
any portion of the residential structure or the land not exceedi one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of ihe�ed b produce income.
E'�,-,-
Land not exceeding 1 (one) acre immediately
d(; -/.3 i3-
ED- BYCIA IMANT 'IN'OTHER'COUNTIES,';`..v:.3,3.
County
Township
County Township
hereby certify the above statements are true, wnreil and complete.
si ature of claimant
Address (number and street, city, state, ZIP code)
L
'ASSESSOR USE ONLY
TRUEeTAX
ASSESSED
EADrA
a
�-
_ cs .. a�.,.sy3.PbS? ufLr
- «VALUE;
_AT700 %.OF..TTV�tu`VALUE
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Otherland
(2)
z %°¢�
prof
r xsY. Y'S:
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'Residential Improvements or AnnuaOy'{L"r"�''�x'"'_
Assam Mobile/ Manufactured Hama
Garage
(5)
Other improvements
(6)
� it
L�
N ->
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed