Homestead_CornwellCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
✓ State Form 5.473 (RS/ 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for fifina instructions.
YEAR
EAR
'r 10 Ti
-'L 3"_}
" 1 2002
ii!�k CERTIFICATION STATEMENT . 4 �-,
I (We)
/W /I jW I he T day of r 0
I (We) occupied as our principal place of residence the following described real property for which a Ho'mes of
,: r q 1
l(We)owned ❑ Are buying under contract -101TOR
I
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.
ig - -- - ---- - - " - - , .. .- .. C CTIRECORDED-1.4i
-Z NW, -Y-,! . ONTRA
If buying on contnict. Fep; to ownl
ed
L=2 —T�
Recordees office wher Wraict is record Record number
-PROPERTY DESCRIPTION A
County Township I Taring district (city, town, township)
I de Wripti AgU el -N is the property' question:
on:
Parcel nu L21 _IOU 'X,,_Real property ❑ Mob-tie Homo (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding we (1) acre that i1nmediatelykurrounds that s6ucture is used to produce income, desuibe the use and portion
of the property utilized to oroduce income.
t%J.. -- -- , -1
T
ASSESSED VALUE
6 -i461-
MiiT 4�
?..,.
,NOWRESIDENTIALg, -
ONLY
R P
-14 -.1
z6i` VALUE_ -
'AT.1100% OF TIV'
VALUE(k
PE W
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
P.-
Other land
(2)
Total land (line I plus line 2)
(3)
Ax
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
;7,. f
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus 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