HomeMy WebLinkAboutHomestead_ShanksVPCLAIM FOR HOMESTEAD PROPERTY TAX FORM CREDIT /STANDARD DEDUCTION Hcto
State Form 5473 (R614 -03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) V Lei T Y�.L�[lJ,_.� certify that on the }fi{ay of March, 20
1 (We) occupied as our principal place of residence the following described real property for which a H.meSIea11r $er�y Tax dYit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract Q
Have a beneficial interest in the entity that is liable for the property taxes on the property and that $(the property or is:buying und` a ontract.
If buying on contract- Fee Simple owner's name
Recorders office where contract is
Record number I Page
et =d
X ' y7a''- 3'. a' -$PROP.ERT,Y.<DESCRIPTIOIi';k'�
County
Township
Testing district (city, town, township) "
P rceI tuber
L al s bon
Is the property in qtr on:
eal property ❑ Motile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that inulled,2tti
of the property utilized to produce income.
sumo Inds that structure is used to produce income, describe the use and portion
11
� � ��,rgASSESSOR.USE ONLY �'�
,� TRUE TAX »4��
iv�VALUE `4`�..,
County Township
County Township
I hereby certify the above statements are true, correct and complete.
ure of imant
C7 (number and street, city, stab , ZIP code)
a +ul A 2 G66
11
� � ��,rgASSESSOR.USE ONLY �'�
,� TRUE TAX »4��
iv�VALUE `4`�..,
ASSESSEDYALUE
;AT 700 /n.OFthr'TaTV.S�VALUEvri
v-HOMESTEADg-r�
NONRESIDENTIAL �I
rb`.YALUEl,.�
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
�'�;"
3 N1
"
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mob6e f Manufactured Home
Garage
(5)
��� �_ .��
:1Wl
". _
Other improvements
(5)
s _
JJ�
r -3
M,
Total Total improvements (fine 4 through line 6)
(T)
Total value (line 3 plus line n
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 1f2 Homestead
Valuation or E35.000
Signature of Auditor
6