HomeMy WebLinkAboutHomestead_Carver0 s CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT /STANDARD DEDUCTION HC10
State Form 5.473 (R614 -03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for filing instructions.
YEAR
L� v" W — L — Z;rfi{y that on the 1st Tay of March, 20
I (We) occupied as our pri /. 1
TV I place of residence the following described real property for which a HomAdt2l�d PGoIedf"3;redit is hereby claimed:
❑ l(We)owned ❑ Are buying under contract
&- Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pmpeor is buying Aer a contract.
NTRACT;RECORDEDy , c� -F�,^ 7 r„'3 - pia +?$,f , . ` i . •�a"+?,.
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
`3-� ' • . `4.r' .��.3 ^. :- `a srxits -' ' `�Y- *"��- h?PROP,ERT,Y-DESCRIPTION'nw. i' '3.',4`..,..;,
= .a? mr— y �V .K;Z S--' "E0
County
Township
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NONtESIDENTIAL}�;a
"'�
Taring district (city, f con
Parcel nu loo SC�
gt71 des ription
claimant
1 /� I Property ❑in que property ❑Mottle Homo ( /.C. 6- f.7 -7)
H any portion of the residential structure or the land not exceeding one (1)
of the property utilized to produce income.
that IrmneIliately-surrbunA that structure is used to produce income. describe the use and portion
•sc C.` t,- ?` t;"`_,_''tP,ROP,ERTY;OVJNEDsBX: CLAIMANT
,IN:OTHER`000NTIESE.sacr".?ti -' ?a
County Township
County
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NONtESIDENTIAL}�;a
"'�
Township
hereby certify the above statements are true, correct and complete.
Si natur
claimant
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Address (nu
er treet, afe, Z e)
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a
�0�
/
S, `- x` , z +-.:
fASSES50R
• TRUEoTAXASSESSEDVALUE
SAT
OMESTEAO�
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NONtESIDENTIAL}�;a
"'�
^`
yq(;UEs.¢
�-.. .. -Te °r
100OWOFTTV
VALUE
Ec#'+ak. _, _ a.
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
x
Other land
T
Total land (line 1 plus line 2)
(3)
Dwelling
(4)'4'}
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(6)
!wrh s %rir
Other improvements
(6)
- -
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
_
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
vaWation or 535.000
,