HomeMy WebLinkAboutHomestead_StallingsCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc�o
State Form 5473 (R614-03)
Resoled by the Department of Local Governnbnt Finance
INSTRUCTIONS: See feverm side Ior MV kifi buct ion .
`J
I (We) c 1s ay o March, 20
I (We) occupied as our principal place of residence the toll described real property for which a Homestea ro Tax Cra ' ,+� reg d:
❑ 1 (We) owned ❑ Are buying under contract ,r Vy
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a;contract.
If buying on contract. Fee Simple owners name
Recorders office where contract is
Record number ( Page
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County
Township
Taring district (city, town, township)
r ber •
/[��ys/I
al de
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Is the ro perty in question:
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Land not exceeding 1 (one) acre immediately
❑ Real property ❑ Mobile Homo ( /.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) tae t immediat y wrrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
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County Township
County Township
I hereby certify the above statements are true, correct and complete.
Si net a of claimant
,
re (number and street, city, state, ZlP cede)
b
..-- t4'.�S.y -mss )". -"�.. .. -'°'_ _+tK
'{' •�-- stir ASSESSORUSE ONLY
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.'-_•• `°"" --
ASSESSEDNALUE
_�.�
+HOMESTEAD
't eNON- RESIDENTUIL <�
OFTNr'?VALUEs'r.--a
VALUE;,
Land not exceeding 1 (one) acre immediately
=ter -i-r'} aR- f'�,•�
surrounding residential improvements.
.s
Other land
(2)
is
M� ., w`
p�
Total land (line 1 plus line 2)
(3)
e;
'�¢_4._
(Residential
Dwelling
(4)-
improvements or Annua0y
Assessed Mobile I Manufactured Home
Garage
g
(5)
�, - `�
x3
„ ".i i. c£
Other improvements
(6)
r I •�„j'�V,
sa-
Trial improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(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 535.000
Signature of Auditor