HomeMy WebLinkAboutHomestead_McKayCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (116 14-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instnxtions.
FORM YEAR
HC10
certify th&n th#IATJ�Affr h4T!�
property -h
:(CWW:4 led `es,n1nc,P8 �Iac-e of re�wjdenc, the �followig described real 1p�m�pety for wh�ichm( stead Property Tax MAY riaf Cd t - h b claimed:
is Ire
I(We)owned ❑ Are buying under contract 0 00 jj
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property %44.Uuying qatipiai contract.
If buying on contrecl. Fee Simple owner's name
Recorder's Office where contract is recorded
County
Township
?71"70: 000, �6 Im I Lef &
If any portion of the residential structure or the land not exceeding one (1) sore that immediatel
of the property utilized to produce income.
a q Oft
Record number I Page
district (city. town, township)
S the property in question;
❑ Real property ❑ Mobile Home (LC. 6.1.1-7)
4'rounds that structure Is used to produce Income, describe the use and portion
BY,,CLAIMANT� IN!OTHER';COUNTIES%��-.�'�-��'..'�,iz ",3'...' K'
County
Tavnshlp
County
Township`
I hereby certify the above statements are true, correct and complete.
Signature of claimant
ress (number and street, city, state, ZIP code)
fljj--'5iji
t,57 RUEITAX6�4;-
ASSESSED VALUE
HOMESTEAD.ji
'M�
i�-,z'�,�!;NON-RESIDENTLAL,�,l�,-.
-z
-V
w
;9��VX:LJE'�
3n i.
Land not exceeding I (one) acre immediately
surrounding residential Improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
improvements
(6)
.94or
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 p1w line 7)
(8)
I hereby certify the above Is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying actlon - Signature of Auditor
Date signed
STANDARD, DIEDuc-nOWALLOWANCIE��i'-'.
20—Pay2O_
Lesser of 1f2 Homestead
Valuation or 535,000
S
SIgnerune of Auditor
Date signed 6--/0