HomeMy WebLinkAboutHomestead_HollanderCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION µG3p x ,
Stale Form 5473 (R614 -M 3
Prescribed by the Department of Local Government Finance it
INSTRUCTIONS: See reverse side for filing inslnictions-
I (We) i' ?KU U ,6'j�� 11}��s�, ,.d certify ton the,lst ay of�March, 2t1 1.
I (We) occupied as our principal place of residence the following described real property for which a Homestead,f? o��yd GreQt�is herebylc)'aimec
o wned El Are buying under contract
�H:e
e 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.
`" 5,•;t".CONTRACTRECORDED"s'a;.,.
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
W.t 3�"`/:.. ex` �` �� ?�'�r.�:�:.�Z''.s�'���i'..�.�.'
-
County
Township
Tarin di riot (cry, to 1 110
Parcel number
^ W \
Legal description
Is the props in question:
property ❑ Mobile Homo (AC. 6./. 1 -7)
H any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
1
ASSESSORUSE ONLY
>' TRUEsTAX *1
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
"dress (number and street, city, state, ZIP code)
to
"l(.3
1
ASSESSORUSE ONLY
>' TRUEsTAX *1
ASSESSEDVALUE
HOMESTEAD:.
NON- RESIDENTIAL
ya�16-
'i ,'zL' 5
VALUE�y �s
i''AT�t OpY. OF�T7V
JMVALUE"�
VALUEn
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
m tr
Total land (line 1 plus line 2)
(3)
Dwelling
(4)-22
�+t
Residential improvements or Annually
qinr. `
Assessed Morita / Manufactured Htme
Garage
- -
Other improvements
(6)`R
r ^47 y' ,yti
y°"y
X'
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plm line n
(6)
I hereby certify the above is We, 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
S