HomeMy WebLinkAboutHomestead_LipscombCLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT /STANDARD DEDUCTION
t s s J State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRIICTInMR- Sao row.ea o;do r.., rr—
%m" a,
i 1 Move
MAY 14 202
ERTIFICATION STATEMENTri -
I (We) cert' �a f ar 20
I (We) occupied as our principal place of residence the following described real property for which a Homestead f €dyJf�e�Gre ' is here armed:
_ e 1
❑ 1 (We) owned ❑ Are buying under contract
® Have 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.
_ &6..,Y «�_jy.ie�'�j�*�''= 'r #'+"- may• -.0 ONTRACT'REC_O_R_DEDz
_ f . `�xt� au n. .g•+ /.»
If buying on contract, Fee Simple owners name
Recorders of where contract is recorded Record number Page
�- '- �n.a�2�.�� arm'` ��-- ��� .`P.ROP.ERTY;OWNED`:BYCLAIMANT IN.OTHER`000NTIES �. spy- ��rc_3�Y�'±•��?�- =•try„
County Township
Cou
Township
Taring distric (city, /, township)
/Pa�r�cel num,.be�ry� ^�
I d
�scpt /Is
�f
the property in question:
� Real property ❑ Mobile Home VC. 6-1.1 -7)
If any portion of the residential structure or the land ne that immediat ly surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
�- '- �n.a�2�.�� arm'` ��-- ��� .`P.ROP.ERTY;OWNED`:BYCLAIMANT IN.OTHER`000NTIES �. spy- ��rc_3�Y�'±•��?�- =•try„
County Township
County Township
I hereby certify the above statements are We, correct and complete.
re of claimant
r
actress (nu, 6 nd street, city, state, ZIP code)
lef2illos-5
20_Pay 20_
Lesser of 1/2 Homestead
Valuation or $6.000
VALUE
AD .,
Hd'
<5
NON,i.rR, ESIDEnN, T L4L-�,
�3r-�-
rtAASSESSED
7j100 % OFT t
F - VALUOMETE�
:...VALUE �...-�•9.x
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)��
L 4 �n f� 4
�' S
Residential improvements
Garage
(5)
t0 ft '` a't"'�'''t:
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of A editor
Date signed
20_Pay 20_
Lesser of 1/2 Homestead
Valuation or $6.000