HomeMy WebLinkAboutHomestead_HyltonCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION H-10
F
StaIeForm5473(R6/4-03)
Prescribed by the Department of Local Government Finance
eff INSTRUCTIONS: See reverse side for Filing instructions. MAY 7 2004
-!;P�RTIF.,!CATION'STATEMENT,R�- hisZr�--
3.0
I (we) /,/Y/ /9'- certify that on VL-ut
I (We ' Q
) occupied as our p pal place of residence ti-A folio m,.ng described real property for which a Homestead Property TlWe'dAt Is hereby dai,ed:'--
1 (We) awned � 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.
oKTRAqT,'RECORDED - - - - - -
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County Township town, township)
Taxing 0a; aco/r-
Parcel nu"r 0(/— scription Is the property in question:
property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion or me residential structure or the land net exceeding one (1) ace that immediate surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. /. a 17"1,4 0— .5'slac'
R%%-R'WW*4M IRE kTXbWWE6�B*.C-aI MANt I N'dTH EkCOWN-hffgft'�F�k�L* jI
County
Township
County —Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, state, ZIP code)
We't 0ax qi4 ew-e/vo-svi
AsS3-S.�"ESSORUSE ONLY
--T
TRUE. AX'
-ASSESSEDVALU
HONEST
i��
E-EMON19E=Si66at 21
VALUE,
I�KV!IVAILUE
Land not exceeding 1 (me) acre immediately
surrounding residential improvements.
Other land
(2)
T' WT
Total land (line I plus line 2)
(3)
Dwelling
(4)
op
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
A
Other improvements
"".vi'
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 pits 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
V0" G�A
gMgg�� �4l�eAi5:i: STANDARD iDEDUCTIONAi!LOWANCE?,I"Z-X.4�',�.EitL-,°Z�;l�i*
Wr 20_ Pay 2O_
Lesser of 1f2 Homestead
Valuation or 535.000 S
Signature of Auditor Date signed V