Homestead_Williams (14)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Foml 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for (ling instnactions.
FORM YEAR
HC10
F fl _ / @ J fl
1 (we) certify that on the 1st day of March, 20
1 (We) occupied 4 out principal place of residence the following described real property for which a Homestead Property- ax Credit is hereby claimed:
C7-'f(We) owned ❑ Are buying under contract (/
Have a beneficial interest in the entry hat is liable for the roe taxes on the roe Pnl f3rgUNTY AUDITOR
b property rty property rty and that owns the id 6r t vying under a contract.
%i'neCONTRACT.' RECORDED' },= .r;sa,
If buying on contract, Fee Supple owners name
Recorders office where contract is recorded Record number Page
a tx:'xs-:^•,x$+%'. ski. A�. r'.; sP ,KOP.ERTY.DESCRIP.TION'>`,'-:w '
County
Township
Taring district (city, town, township)
Parcel number b
(,,age] escription
Is the property'
p PertY i question:
C010 /S '
eel property ❑ MoWe Homo (I.C. 67.1 -7)
If any portion of the residential structure or the not exceeding one (1) a unmediatety surrounds that s cture is used to produce income, describe the use and portion
qq
Of the prOpCrty {It1IR�ed{'tp pmdnte IfICOme.
(2)
t'aWiWTT
F' v.. f
+£iPROP.ERTY;OWNEDBY CLAIM ANT IH: OTNER
County
Township
County Township
hereby certify the above statements are true, correct and complete.
Si a of clad ant
Address (number and street, city, state, ZIP code) Ir
�- : ASS USE OLY
-
TT
�VALUsY
ASS; VAUE
FV
iTT�
1 HM
MN ._5,riVALUE�. +'i5
r N DAESSOR
VALUE�SSED
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
t'aWiWTT
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tip=_. -a
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
yye+ri F,+ O.
nr,;,"�r.�_
'Residential improvements or Annually
Assessed Mobile I Manufactured Home
Gara a
()
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(S)
1 hereby certify the above is tine, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535,000
Signature of Auditor