HomeMy WebLinkAboutHomestead_LinxwilerCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Govemmnt Finance
INSTRUCTIONS: See reverse We for riling instructions. PJ L
I (we) ( dew 5-r ( 1) / " 1j1JLe-V4t1) ce)gwthat on the 1st day of March, 20
—
I (We) occupied as our principal place of residence the following described real property for which a Homesteadl-erp C44 is hereby dalmed: ✓
I (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 prop" or is buying under 'a contract.
-RA(Zr-RECORDED . . . . . . .
If buying on contract, Fee Simple o rs name
Recorders office where contract is recorded Record number Page
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County Township
County Township
County
(ol 16 Q6 ox,
Township
A777and street, cd)� state, ZIP code)
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district (cily, ton, township)
W'7'bD9�1-00
L anal
description
Is the pro lion:
surrounding residential improvements.
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S�RVproperty ❑ MbI1s Homo (LC.6-1J-7).
If any Portion of the residential Structure M the Land not exceeding we (1) acne that immediate
surrounds that structure I is used to produce income, describe the use and portion
of the prop" ufW7 to produce income.
d
Total land (line I plus line 2)
(3)
I
oc
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County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
A777and street, cd)� state, ZIP code)
I A 0 V /144
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ASSESSED.VPLUE
jp—HOM-E—ST�EADA
LEMMA
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AM
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Land not exceeding 1 (one) acre immediately
N', --A W
surrounding residential improvements.
(1)
I
Other land
(2)
rores
Total land (line I plus line 2)
(3)
Dwelling
(4)
Mr.
RN W ® 15
Residential improvements
Garage
At
WE
(5)
Other improvements
(6)
WIN
Total improvements (line 4 through Me 6)
(7)
Tdal value (fine 3 plus line 7)
(8)
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 $6,000
Signature of Auditor