HomeMy WebLinkAboutHomestead_HopperCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. 77 y
I (We) J d[.m Q S N L M- be 14-D r certify that'tin Re4stUX AAamh, 20 _
,11((We/) occupied as our principal place f residence the following de cribed real prop rty for which a Homeste - Property Tax Credit;is hereby claimed:
E1 I (We) owned ❑ Are buying under contract �J,
ift Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr6 Ptyor fslbtly,ngAuddeT a;wnVact.
� � 'u�iEx°.x''^ °%c: .''R .3s£.' .'. '..a`'•'Q, -r ,`rwr`iCONTRACT:RECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
ai:asr, it .F,. �OltOPERT,Y:dESCRIPTIONiVr'�
Ca
Township
County nship
Taring dis
t (a ,to tow hip)
Parcel number
OD 3 11 J D
Legal description
F rc JQ
O
Is the property in question:
-�Rea1 property ❑ Mobile Home (I.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding
of the property Utilized to produce income.
&a (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
Tr' i.'[ -A✓x tiF �a�.,�+'lq f/. lt: _ -P. Ek -.. _. ..
ERTY, OWNED ;BI!CLAIMANT,IN:OTHER`COUNTIES
County
Tavnship
County nship
I hereby certify the above statements are true, correct and complete.
Signatur of!ylaimarn
Address (numbe% and street, city, state. Z code)
Wc,-s %
�Uki�blit@s blhlLW x ' «.'..
` { ^ §AtEc pS NLaia*
TRUE TAX r•
VALUE} �5�'
ASSESSED VALUE
a AT 100 %_ OFTT1/�VALU
HOMESTEAD
ANON= RESIDENTIAL•"'
:r V3'seVALUEssi$'ia
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
tk, 3
Trial land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Dwelling
Gara y a
(4)
(si
K 5
xir + -•-� xrSr'Zgo '::'
°" -'"•' °_
�•r v . t `F res`.
ash"
Other improvements
(6)
4s
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line n
(g)
hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed