Homestead_BeadlesCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
Slate Form 5673 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing inslnrclions.
I (We) certify that on the 1 st day of March, 20
1 (We) occupied as our principal p[aCVf residence the following described real property for which a Homestead Prof'TA)C'redreby claimed:
❑ 1 (We) owned ❑ Are buying under contract
rl Have a beneficial interest in the entry that is liable for the property taxes on the property and That owns I a property or.is buyi g n /r
under a contract.
CONTRACT'RECORDED
If buying on contract, Fee Simple owner's name
Remrder's office where contract is recorded - Record number Page
"V " x"y_m aY3xs
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--,.r 3P,ROPERT:Y:OESCRIP.TIONs.�? a *')x``'s
County
Township
I hereby certify the above statements are true, correct and complete.
Taxing district (city, town, township)
p reel n tuber
Legal
w.,ss VALUE
Is the property in question:
Land not exceeding 1 (one) acre immediately
Date signed 1-0 Ll
❑ Real property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceed
one (11 acre that immediately surrounds that structure is used to produce income, describe the use and portion
or the property utilized to produce income.
OWNED;BY CLAIMANTiIN: OTHER`COUIJTIES'�:�:lx,,:_3;�?�
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
S net
a claimant
Address (number and street, city, state, ZIP code)
w.,ss VALUE
LJ
an' ASSESSOR(USE ONLY �z K w�
rims
i' TRUE TAX 5?
ASSESSED VALUE
HOMESTEAD �-
NONIRESIOENTIAL ",
We
si "a'a""} -' 4' .Ti.'.Fc,,,4 } 'a,,,., y...17�"`Ai? a3
� .Ei.VAL:UE'`.i raata
µA7100_ %a OF'TTV4
w.,ss VALUE
VALUE .-: E'.
Land not exceeding 1 (one) acre immediately
Date signed 1-0 Ll
surrounding residential improvements.
(1)
Other land
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Motile I Manufactured Home
Garage
(5)
t ;...
t'
Other improvements
(6)
r
IN
Trial improvements (line 4 through Me 6)
(T)
Total value (line 3 pits line 7)
(6)
hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
o-' 3t>.i::STANDARU:DEDUCTION 'ALLOWANCE +,..?n,''-`y�
20 _ Pay 20 _
Lesser of 112 Homestead
vauatton or 535.000
S
Signature ofPudiiw
Date signed 1-0 Ll