HomeMy WebLinkAboutHomestead_Williams (15)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Gowemmenl Finance
INSTRUCTIONS: See reverse side for filing instructions. I
(we) l � W- ZU7,7uee"
(We) occupied as our principal place of residence the following described real property for which a F
❑ l(We)owned ❑ Are buying under contract
'
Wave a beneficial interest in the entity that is liable for the property taxes on the property and that
i
FORM YEAR
certify$gtobn
_pql� iZ March, 20
stead Property Tax � hereby claimed:
aq i CONTRACT'RECORDED--1',-
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number
contract.
-%PROPERTY.`OWNED BY CLAIMANT IN OTHER 'COUNTIES !'�
'PROPERTY DESCRIPAION
County
65
Township
Township
Tadn is il (cyy, town. township)
P I ber
Nz
L
�M;y
is tf/roperty, in =estion:
—
.BJ
1-7)
Real property ❑ Mobile Homo (I.C. 6-1.1 -7)
If any portion of the residential structure or the land rill exceeding one (1) acre
t immediately surrounds that st;ucture is used to produce income. describe the use and portion
0
of the property utilized to produce income.
Land not exceeding 1 (one) acre immediately
-%PROPERTY.`OWNED BY CLAIMANT IN OTHER 'COUNTIES !'�
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
n r claimant
..s; (number and street, city, state, ZIP code)
a�
6: .
x- r_�—LASSE-
ASSESSOR USE ONLY
-TRUE -TAX-
ASSESSED VALUE
HOMESTEAD S"T E'A' D"
,;NON-RESIDENTIAL,.-
t.
a VALUE;
kT.1000%'OF.TTV-
"VALUE
i.
.BJ
Land not exceeding 1 (one) acre immediately
surrounding residential improvements-
Other land
(2)
Total land (fine I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total 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
complete.
Verifying action - Signature of Auditor
Date signed
STAN DARD. D E DUCTIO N ALLOWANC E
20 _ Pay 20
Lesser of 1/2 Homestead $
Valuation or $6,000
Signature of Auditor Date signed