HomeMy WebLinkAboutHomestead_PastoreCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION FORM
State Form 5673 (R817 -07) HC10
Prescribed by the Department of Local Government Finance �g-�-1
INSTRUCTIONS: See reverse side for filing instructions. ff� I 1 (f-1
YEAR
I (We) ( /i17/il7.Q LC`azO"C -'Q certify that on the 1 st day of March, 20-
1(We) occupied as our principal place of residence the following described real property for which a Homestead.Property Tax Credit is hereby claimed:
d�a«G
I (We) owned ❑ Are buying under contract N ��1 y/ ,,qq������ nnRR
Have a beneficial interest in the entity that is liable for the property taxes on the property and that 0APttl9p #0'r Is ouying Snder a contract.
CONTRACT ••D
If buying on owdract, Fee Simple ownefe name
Recorders office where contract is recorded Record number Page
.PROPERTY OWNED BY
County Township
County nship
I hereby certify the above statements are We, correct and complete.
Signature of daimant
PROPERTY
AT 100% OF
County
Township
Tatung strict city, t ,fawns
parcel number
Legpr]tlescnPG
I Is the property in question:
surrounding residential improvements.
JCi.I. ///CEO
i ❑ Real property ❑Mobile Home (IC 8 -7.1 -�
If arty portion of the residential structure or the land not exceeding one (1) sue t ion
of the property utilized to produce income. Oa G S� / _ OG
iately surrounds that structure is used to produce income. describe the use and portion
a -a3 �(o ao0
.PROPERTY OWNED BY
County Township
County nship
I hereby certify the above statements are We, correct and complete.
Signature of daimant
_6ess (number and slrw1 city, stale, and LP rode)
ASSESSOR ONLY TRUE TAX VALUE
ASSESSED VAL
HOMESTEAD
-NO.N-RESIDENTIAL
Lesser of 12 46,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation
AT 100% OF
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
Data signed (month, day, year)
surrounding residential improvements.
Other lard
(2)
Total Land (line 1 plus line 2)
(3)
Residential improvements or Annually
Dwelling
(4)
-
Assessed Mobile I Manufactured Home
-_
Garage
(5)
- - <`s•r, '. -
Other improvements
(6)
_--
Total improvements (fine 4 through line 6)
(T)
Total value (line 3 plus line 7)
(8)
1 hereby Certify the above is true, correct, and
Signature of Assessor
Date signed (month. day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day ynad
STANDARD s r
_ Pay 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 46,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation
$
a 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Data signed (month, day, year)