HomeMy WebLinkAboutHomestead_CoxCLAIM FOR HOMESTEAD PROPERTY TAX
FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
N,
State Form 5473 (R6/4-03)
Prescribed by the Department of Local Govemmernt Finance
INSTRUCTIONS: See reverse side for riling Instructions. -W--1 -117 'ir '7-1
I (we) Y,16A A ffdn k IV g2s�,IJO=.± ce ' atjjn
tK jj�jay of.March, 20
I (We) occupied as our principal place of residence- the following described real �znrwhirh a Home t p T dit Is hereby claimed:
rl I (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 th42pa�! !is under a contract.
CONTRACTsRECORDEDIZ, -4.
If buying on contract. Fee Simple crtmer's name
Recorder's office where contract is recorded Record number Page
PROPERMIJESCRIKTION4v'�n-.:
County
Tamnship
Township
Toding district (cdy, to", township)
6MO1
OvD,
Legal dEU' r' n"
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Is the property in Question:
❑ Real property ❑ Mobile Home (LC. 6-1.1-7)
If any portion of the residential structure or the land not exceeding we I
of the property utilized to produce income.
that immediately surrounds that structure is used to produce income, describe the use and portion
Y-,Z"'r,�i'`e �--,;PROF!ERTXOWNED'BY,CLAiMANTINIOTHERI-COUNTIES-�2t
--[To-,vnship
County
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
0 ress (number and street city, state, ZIP code)
'STANDARDjDEDucTioN-ALLowANCE�-,:.,
Row 20_ Pay 2O_
Lesser of 1/2 Homestead
Valuation or 535,600
Signature of Auditor &Aof Is signed 5-/O-oj-
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eAidsib'V Ge
t'L�"H-0--M'-E-S-T'E-A-D
*71,TNON-RESIDENTIALF-
R M
MOW
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Land not exceeding I (one) acre immediately
surrounding residential Improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwellin g
4
()
W
Residential improvements or Annually
it
Assessed Mobile I Manufactured Home
Garage
(5)
,?;bar improvements
(6)
%
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
'STANDARDjDEDucTioN-ALLowANCE�-,:.,
Row 20_ Pay 2O_
Lesser of 1/2 Homestead
Valuation or 535,600
Signature of Auditor &Aof Is signed 5-/O-oj-
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