HomeMy WebLinkAboutHomestead_PearsonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
V State Form 5.473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See femme side for riling instructions.
FORM YEAR
HC10
I (We) - &%AVAAA, . LJ d- �" [A E&C� certify thA"ePsocing arch,20—
I (We) occupied as our Vncipal place of re _ )Ilowmg described real property for which a Homestead Property Tax Credit rereby claimed:
l(We)owned ❑ Are buying under contract >t7l' 4��
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns qWFMpdtX )Lpyinander a contract.
zz
If buying W contract. Fee Simple owner's name
Recordee a office where contract is recorded Record number Page
� County
Portion of the residential structure o
property, utilized to produce income.
Township
not exceeding we (1) acre that
town, township)
Is the property in question:
❑ Real property ❑ Mobile Home (I.C. 6-1.1-7)
vends that structure is used to produce income, describe the use and portion
C
PROPERT.Y. OWNEDBY'CIWMANT;IN'OTHERICOUNTIESi.; I - A�i: 1. �" �" -,!., -': -
County
Township
County
ow nship
Township,,
1 hereby certify the above statements are true. correct and complete.
Signature of claimant
msa (number and street city, state, ZIP code)
0111W
iTRUETAXW---4T
�' 1- 1,
S
AS ESSEDYALLIE
-
� �HOMESTEWI-
�'f,',,,.j:NON-kESIDwm
.ASSESSO!t_qS
'12.,�-�',VX4E-
,
's-"AT 0 OFJTV-T;��-7-�VALLIE.f�-,�'c
Land not exceeding 1 (one) acre immediately
V,
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)
'Plot improvements
(6)
Total Improvements (fine 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.
VerifOg action - Signature of Auditor
Date signed
20 _ Pay 20_
Lesser of 112 Homestead
Valuation or $35,000
S
/ F%
Signature of Auditor (3 /�-i, --� ----T ate signed S