HomeMy WebLinkAboutHomestead_BaileyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
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State Form 5473 (R2 15-92)
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INSTRUCTIONS: See reverse side for tiling instructions.
FORM
HC10
M-11=11
YEAR
t CERTIFFIICATIO TATEMEENT�
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1 (We) ` �� V �Y/7'�c certiftt*u 120 of March, 19_
I (We) occupied as our principal pl ce of r sidence the following described real.property for which a Homestead Property Tax C — a is he by imed:
❑ 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 5@ g)�(hQ,l1A1�� tract.
16
CONTRACT RECORDED "
It buying on contract, Fee Simple owners name -
Recorders office where contract is recorded
Record number
Page
PROPERTY DESCRIPTION - eq
Counry
18 d
Towns hi
7
Taxing district (city, fo ownship) c /1
7Z� / Z
Parcel number %
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Legal description
If any portion of the residential structure or theta t exceeding one (1) that immediately Hounds that sbucture i d to Droduce income, describe the use and portion of
the property utilized to produce income. /�-
lacre
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
County
Township
County
Township
Si ur of claimant
®ereby certify the above statements are true, correct and complete.
_
Add r number and street, city, stare, ZIP code)
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I
ASSESSOR USE ONLY
TRUE TAX
ASSESSED
HOM STEAD
NON- RESIDENTIAL
VALUE
VALUE
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4) -
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assesor
Date signed
complete.
Verirying action - Signature of Auditor
Date signed
STANDARD DEDUCTION
ALLOWANCE
19_ Pay 19
Le er of 1/2 Homestead
S
V ue or 2,000
Signature of Auditor
Date signed