HomeMy WebLinkAboutHomestead_ElliottCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 IRS 110-01)
wr Prescribed by the Department of Local Government Finance'
FORM YEAR
HC10
I WkAY.A-M X- 3L Ck certify that on the 1st day of March, 20
�1 (W upied as our principal place of residence the following described real party for which a Homestead Property Tax Credit is hereby claimed:
I ("We, owned ❑ Are buying under contract
eHave 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 co . ntract.
CONTRACTzRECORDE
F S. pi
If buying T=� or`5 nap
Rewidef s office where, contract is nicory Record number Page
- -- 0Eftr4bWj4 It cFst' cEk I M A kT. I 14-0t A E kt-0 IJNTI[
County Township
County
Twmship
township)
Parcel number
W"a
Is the propertyinqu Eon:
Zeal
ntL� i5o?).JS —56
�j .4
property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utili7M to produce income. 4 t DL5 / a� vT
a L -00 -!�q / -7 - all. 3a -C/ (�?
Total land (tine I plus line 2)
- -- 0Eftr4bWj4 It cFst' cEk I M A kT. I 14-0t A E kt-0 IJNTI[
County Township
County Township
I hereby certify the above statements are true, correct and complete.
SignC�,mant
ress (number and state, ZIP code)
(1)
— A
ISARMDEDILICTIOWALILOWANCE-1�
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Date signed
0 TRUE,TA X W-W,
N, VALUE r,� -44
"j&S
HOMESTEADR�
IMONI =ESlDEtVU4
r*Munff
Land not exceeding 1 (one) acre immediately
surrounding residential Improvements.
(1)
-N
W,
R. WOMEN=
Other land
(2)
Total land (tine I plus line 2)
(3)
Residential improvements
Dwelling
(4)
M
A
Garage
(5)
SAN a
Other improvements
(6)
NOR' WWK-�- mq-�'
Total improvements (fine 4 through line 6)
(7)
Total value (fine 3 Plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
ISARMDEDILICTIOWALILOWANCE-1�
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Date signed