HomeMy WebLinkAboutHomestead_Bryanttin
e CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Fomt 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for fifino instructions.
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I (We) "Ztp is a of rch 0 `
I (We) oaupi as our principal place of residence the toll ng described real property for which a Hom, �T. UU n claimed:
❑ I (We) o ed ❑ Are buying under contract
lave 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.
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Q C(O At
Recorder's office where centracl is recur ed Record number Pag
',s`±v' = .s PROP, ERTY. OVYNEDiBY�CLAIMANT ;IN'OTHER'COUtJTIES; 1€ rn 3, '
P, RO PIE RTY;DESCRIP,TION
Counfy n
Township
Taci di (city, to ,tow ship)
Paryel num r /
Legal description Is the openy i question:
100%OF.TM
Real property ❑ Mobile Home (I.C. 6- 1. 1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
',s`±v' = .s PROP, ERTY. OVYNEDiBY�CLAIMANT ;IN'OTHER'COUtJTIES; 1€ rn 3, '
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
S" at a of claimant
100%OF.TM
Oress (number and street, city, state, P e)
- 0 9 4!E--
r -v`4 VALUE s !yt°
VA
ASSESSOR USE ONLY
T"TRUE TAX"'
'y>,a
ASSESSED VALUE
>'- HOMESTEADY -y
NOON- RESIDENTIAL
Valuation or $6,000
$
100%OF.TM
"WALUEr?3L:
r -v`4 VALUE s !yt°
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
;ti =rr, ,.,..�� ,'X' -',-
Other land
(2)
Trial land (line 1 plus line 2)
(3)
Dwelling
(4),F+r°
.:cr° 5
Residential improvements
Garage
(6)
_
S�
Other improvements
(6)
F�-. aT. v�
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, corned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARMDEDUCTIOWALLOWANCE,
Wr Pay 20
20 _Pay 20
Lesser of 112 Homestead
Valuation or $6,000
$
Signature of Auditor
Date signed