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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FORM YEAR
PALED
I (we) � -in�:g % % r1i ��� Zia certify thaicn the 1st day of March 20
1 (We) occupied as our principal plas 0 a folio I/ / (,4 ' 4—
wmg described real property for which a Homestead Property Tax,Credit is hereby claimed.7
[(We)owned ❑ Are buying under contract
&ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
NTRACT.!RECORDEDk.
If buying on contract. Fee Simple owners name
Recarder's office where writract is recorded Record number Page
�.��--PROPERTY--OESCRIP.tldNq�
County
Township
Taxi isinct (city, to township)
Parcel number
Legal description
Is the property in question:
Signature of a .
&1;7b; and street, city, state, ZIP code)
, Fir ,,,- /,v '-/ 76
Real property ❑ Mobile Home (I.C. 61.1 -7)
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.
R5K, -%�0-koVEtiti-y-bWNE6,-Bi'CEklM-A-i4t INIOTHER"COUNTIES
F,4TRL!EiTAX�
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of a .
&1;7b; and street, city, state, ZIP code)
, Fir ,,,- /,v '-/ 76
gw
ASSESSORILISE" ONLW�'
F,4TRL!EiTAX�
ii�SSESSEDMALILIE
A;HOMESTEAD'��
7,M40 NON -RESIDENTIALT, h.
4
kT,100%TOFT.rw
-:z� VALUE
Wls!1511WAILUE";�-�L I
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus fine 2)
(3)
Dwelling
(4)
101
Residential improvements
Garage
5
()
Other improvements
(6)
sue- --
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TANDARD:DEDUCTIONALLOWANCE79��:�Zct
20_ Pay 2O—
Lesser of 1/2 Homestead
Valuation or $6.000 $ 1
Signature ofjditor 1-1A O�A Date signed
I X-S- 0-1
� ;, CLAIM FOR HOMESTEAD PROPERTY �AX
CREDITISTANDARD DEDUCTION
♦ / State Fwm Sa73 (R6 / a-03)
Prescnbed by t�e Departmem ol Local Govemment Finana
INSTRUCTIONS: See revcrse side /oi filing fnslrur,linns.
�33�'c:.t::,..,....__....,_.. .. ..a:z.+-•�_..._ �_ ., .. . ..�....��,..�
9 FORM YEAR
� HC10
� M'el _ / /(.C�(_i " / / IiC.C.C.C.!/]`Y�-� certiry t�a�qp tqe �t���
I(VJe) occupied as our principal place o( residence the following descnbed real property for which a Homestead Pfd er�y �sc redit is
❑ i(VJe) owned ❑ Are buying under contract `�j /�
� Have a benefidal interest in the entity that is liable for lhe properry taxes on the property and that owns the pro(feA�s b�u
AUD
:s,:_ . ... . _ �,.:; - . . _. .. � �,:
c :isxz'r: ''h�,2qy-`t ,rT .: - �"-` :. . :, r-:-�' � - . _ �=e:,. CONTRACT�RECORDED'. . �_,.. �- � . , : ..;`
If bv�ing on contrad, Fee Simple awner's name
Recorders otfice whera wntract is recorEed
7o.vnship
Taing
Yvv...J W �V ! � I �1 e�J `IW I `(l—� � F7a � • �T7� l�e Oro�
.�
If any portion ol the resitlenGal strucwre or the tand not exceeding one (1) acre that immediately surtounds that
o( the properry utilizetl to produce iriwme.
a�- i��� -3�� - a�. �29- ��r
�.,i'++`�.+. "':`v '�=�'" �PROPERTY�OWNED�BYCIAIMANT�IN�OTHER`COI
County Tavnship County
I hereby certify the above statements are true, coned and complete. � ature of c�nt
ddress (numberand (reet, cdy, sta(e, ZIPCOOe)
%�f� 3 �k 3�2 �,.�� ►�1�'c��' � IF
Rewrtl number
March, 20
hereby Gaimed:
nder a contract.
ITOR
Page
- - �`=r'".,.-."-.�,: -, . _
alproDerty ❑ Mobilo�lo�o(I.Qbt.fd)
is used lo praduce inwme, tlesctibe ihe use and portion
e
� i
�- „� ��� ,� � ASSESSOR-0SE ONLY �_ . TRUE TAX ASSESSED VALUE �� �HOMESTEAD ` NON-RESIDENTIAC„
.,.�y�A�.��y � ,s ,. r.,:h. . VALUE AT100%OF_TTV - � VALUE"_ � ;i'VALUE: ��� .
Land not exceeding 1 (one) acre immediately -, : " �� ` � �.
surrounding residential improvementa (�) . �. ' - ..� �
Other land (z) � - .
Tdal land (line 7 plus line 2) (g) I
Dwelling (4) . .
Residentlal improvements or Mnually � ' 4 _ _
AssessedMobilelManufacturedHwne Garage (5� :;���-f"�"'��`'Y"-:��� ••
Olher improvemenis (6)
Tnal improvements Qine 4 through line 6) I(7�
Taal value (line 3 plus line n (g�
I hereby certify the above is true, cortecl, and Signawre o1 Asseswr Date signed
complete.
Veritying actbn - SfgnaNre of fwditor Date signed
,.z;:.:-.;,5: �-'-->-;>- : � -�" - _.STANDAR�.DEDUCTIONALIOWANCE"--• .. • - . - - _ .
20 _ Pay 20 _
Lesser ot 1/2 Homes;ead -
vavauon or E35.000
S