Homestead_Williams (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for Filing instructions.
°'3 ^�$'?� - �=•i'1 ys�:_.. °T�+ ;;..�41��`� =?�. `�CERTIFIC ON -STA MENT ":.. .
I (We)
I (We) occupied as our principal place of residence the following 4es4nbed real property for which a
❑ I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the
FORM �� YEAR _
HC70
3 IZ0@W of March, 20
fax Credit is hereby claimed:
YVI
r a contract.
ITY ALIBI
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e` tre��i--`= �u 'S?'ezr41.dt�hL'tt'a°"�ti:'r'i�, arCONTR.4CT'RECORDED._�vc.% pat' � "'-- ��_�'4*'..���-,�.x�,....� -.
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
.. ui - p- r� •:zra•�y�ess fir - .r- __ ..____ _
i s:. 3 Rlotri, ,..z g�'d P,ROP,ERT.Y•DESCRIPTION; ;�17- t'�'.1 .A�-`. s` -,r .-�n't'•$S -? o 'g'�. • 3.a �,=.
County
Tumship
Taxing district (city, town, townshi
Parcel / nn�umb((er� p
Of 1p -' `f�� 0 ��
Legallddees�cnption
W
Is the property in question:
eal property ❑ Mobile Home (I.C.
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.
u M— __. .� _.- _
•= s"9. a �_ "= •r .W, PROIR - bWNffale CL'AIMANTAW OTHER' COUNTIES? - ';.` ..;<t''�?j� yS4 '+ '•-" -:.. x,�.orj.�!' -""4
County
Township
County
Township
I hereby certify the above statements are We, correct and complete.
si ure of claimant
T
W"d e^ +d ess (nu her and sheet city, state, ZIP code)
l V
`''' - v^ -�'.t yn,,� T"•�`ve t
�* jASSESSORUSE ONLY -i
i'�.�. > �aa.�I+'{yi' ;u.ro•�- _��s_' r,�
^kTRUE TAXI,
d
ea�VALUEs•`"„1"y.�T
ASSESSED VALUE'
_AT 100 %OF-TTVs�
+HOMESTEAD -Z
.. VALUE'a
NO - RESIDENTIAL'' %
a .
?" mar tV./j - �VALgEP
Land not exceeding 1.(me) acre immediately
z^` 'K , •' n °rr,iy;
surrounding residential improvements.
1
O
a n= �s'r
Other land
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
,
I Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
�.�yrs'j�• "' -'
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
r_
-- STANDARD'.DEDUCTION ALCOWAIJCEtt...,` .jc'•
20_Pay 20_
Lesser of 112 Homestead
Valuation or 535.000 S
Sgn f rill r
Date si e ���