HomeMy WebLinkAboutHomestead_Williams?4 rt CLAIM FOR HOMESTEAD PROPERTY TAX FORM f�
YEAR
CREDIT /STANDARD DEDUCTION Hc10
y State Form 5473 (RS 110 -01)
rn� Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
d CERTIFICATION STATEMENT'_ .
I (We) _ _ at on the l!1��st[,da�Yrj'�V�1fr�P7garch, 20
1 (We) occupied as our principal place of residence a following described real prope y for which a Homestead Proq ax�y.irldiN7 Ykreby claimed:
I a) owned El Are buying under contract //,� / C�%1J
ou
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns tho'property�er±�,buy ynAor�� act.
CONTRACTBECORDED _ _ -
I buying on contract. Fee Simple owners name'
Recorders office where contract is recorded Record number Page
- PROP. ERTYOWNEd BYCLAIMANTINOTHER- COUNTIESi '':. r` fl. _`- r''�
.Township
-PROPERTY DESCRIPTION • - �.r ° .' ^�
- -
County
Tomship
.�s +NON- RESIDENTIAL
'1
Taxing nct (city, town, towns ip
Parcel number K
_75
Le al description
Is the property in question:
1 ❑ Real property ❑ Mobile Homo Y.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeMg
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.
surrounding residential improvements.
- PROP. ERTYOWNEd BYCLAIMANTINOTHER- COUNTIESi '':. r` fl. _`- r''�
.Township
County
Township
County
.�s +NON- RESIDENTIAL
'1
I hereby certify the above statements are true, correct and complete.
Signature of claimant ^ r
L/1GZYJ�
ress (number and street, city, state, ZIP code)
• ASSESSOR USE ONLY �t .S
iTRUE TAX -
_ASSESSED VALUE
MOMESTEAD
.�s +NON- RESIDENTIAL
'1
� - .F
'? .� VALUE.
AT 100 / OF.TTV
VALUE :'i
r VALUE.
Land not exceeding 1 (one) acre immediately
Date signed
w " ` `
surrounding residential improvements.
11)
' -- " Y' ,
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
r; ''1A•r' �- tii"`�'cF!°
Residential improvements
Garage
-4
6
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I 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
S
Valuation or $6,000
Signature of Auditor
Date signed