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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R6 / 4-03)
Preacrited by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling Instructions.
FORM YEAR
HC10
I (We) 1h-ttlm #f Ga�rU that on the 1st day of-March, 20
I (we) occupied our principal placdWof residence the following described real property for whi 0 is hereby claimed:
I (We) own ❑ Are buying under contract 11 ftol!o
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.
RECORDED'---
If buying on contract, Fee Simple owner's name
0113SON COUNTY AlintTric,
Recorder's office where contract is recorded Record number Page
PRO PE RTY� 0 ESC RI P.71 OW'�
County
ToNnship
Taxing district (city, town, township)
Wr-0301YOO
doln
L
Is the property In question:
VAL41
1_51
Land not exceeding I (one) acre immediately
❑ Real property E3Mobile Home (I.C. 61.1-7)
If any portion of the residential structure a Me and not exceeding we (1) 13M that immediately surrounds that structure is used to produce income, describe the use and portion
of the Property Utilized to produce income. tic,
I Xii ASSESSOR USE 'ONN.
0 R 0 0 E RTY,'O WIN ED: 9 Y. C LAJ M A N T,'! N'OT H E R i C 0 U IN I I E S
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
0— ress (number and Street, city, state, ZIP wool
I Xii ASSESSOR USE 'ONN.
EJRUE�TAX V,
ASSESSED VALUE
HOMESTEAD
-2 -RESIDENTIAU�,�-
'NON
#�VALUVI'F��'�'
• 'AT -100%'OFf
VAL41
1_51
Land not exceeding I (one) acre immediately
X
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
V&
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
V -
(5)
- - - - -
improvements
(6)
r t �A'
'O9Aer
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 pits line 7)
(8)
1 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 12 Homestead
Valuation or 535,000
c,,--STANDARDDEDUCTION'ALLOWANCE-,-
L
Signature ofAuditor d
f Y) /2 1 jj. (A ) 4\ n L_• I Date signed _