HomeMy WebLinkAboutHomestead_WhalenCLAIM-:FOR HiOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION - HC10
State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
I (W Li_" 800'_�� certify that on the 1 at day of March, 20_
residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (W:� occu i Y as r nci I pi of
V
I (We) owned ❑ Are buying under contract
that omlslpr
Have a beneficial interest in the entity that is liable for the property taxes on the property and jejor is 4= ule-7kcontract.
If buying on contract, Fee Simple owners nami,
Recorders office where . contract is recorded 01884 M Paga
TKV-m0 PROPERTYOESCRIRTIOW�f�`
County Twnship
County
Township
I hereby certify the above statements are true, coned and complete.
Taxing district (city; to", township)
611 C1.
LebM
ISIO
desaiption
j4aLwD14r
QO/%
the property in question:
❑ Real property ❑ Moblio Home (LC. 64.1-7)
If any potion of the residential structure or the land of ex eding we (I ) am that immediAely surrounds that structure is used to produce income, describe the use and portion
of the property UtULW to produce income.
:W;r;'PROO.tRTY—iCiWNE6.BY'CLWMANT;IN'OTHEFtr(j-OUNTIES"',�'�;
County Twnship
County
Township
I hereby certify the above statements are true, coned and complete.
Signature of claimant
dress (number and street, city, state, ZIP code)
ASSESSOR USE ONLY�
K��,TRUEJAX�;J�.
ly, *
Al! SESSED�VALUIE
�f.`.HOMESTEAD."�
'RESIDENTIAL�,,;-`
NON-
P�VALUEW�;i X
100 P,
U E
$
,:jj
Signature of Auditor
(Y1aAA4_
0
_Vi�l
Land not exceeding I (one) acre immediately
surrounding residential Improvements.
Other land
(2)
W,
_4, k'A
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile i Manufactured Home
Garage
(5)
,O�per improvements
(6)
Total improvements (line 4 through line 6)
(7)
Tctal value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION "ALLOWANCE
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or 535,000
$
Signature of Auditor
(Y1aAA4_
0
Date sivld _Ir
,3 r) %,
0 LINJ
0