HomeMy WebLinkAboutHomestead_ReedCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions. U T T U n
I (We) certify That on theolst� day ofMSr�cFi,O
(W u -ed as our prindpal place of residence the fol 'ng described real property for which a Homestead Pre erty Taz Credi is Ita "reby daimed:
I (We) owned ❑ Are buying under contract Jq //L{,l/
Have a be"l l interest in the entity that is liable for the property taxes on the property and that owns the propefq{ �Ritiylr�)jllni�eda- ctiriGH'U.
u ?CONTRACTRECORDED�
It buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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=Vm4- .�:% —W; :dWP,ROPERT.YsDESCRIPTION� . +o-.� ..'., 'a;�:-
County
Tormship
Taring d' ry town, tow ip
shi
m ^
3 'YVl
Legal descdptien
a3
I the property inquestion:
Cf heal property ❑ Mobile Home ill 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.
^ ,�'L ages
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�.- .;, .ia-. • nr ._A -. . _ _.j _. _ ..` . .. . -_ —.. -
r,`.ar'x PROP.ERTV;OWNED;BYCLAIMANT.INi OTHER' COUNTIES}:r.- :;'+✓rs,,..,;w
County
D
Townshi
shi
I hereby certify the above statements are true, correct and complete.
Si lure of claimant
dress (number and stris
G
I. city, state, lP code)
(o
Ir
rid 1
-+�� SSESSOR USEONLY' �
TRUEITAX
ASSESSED VALUE.HOMEST
D
N NO !RESIDENTIAL''h
VAL:UE
AT 100 %OETjTV
` `�VALUEE5V0
ALUE -s z
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
Other land
2
` Kit
Total land (line 1 plus line 2)
(3)
Dwelling
(4)rv`b
- �z4F
Residential impmvementa or Annuagy
Assessed Mobile I Marprfactured Home
Garage
r
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
valuation or S35.DDo
Date signed
1004