HomeMy WebLinkAboutHomestead_DircksCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HCto
♦ State Form 5473 IRS 110-01)
ur Prescribed by the Department of local Government Finance
INSTRUCTIONS: See reverie side for Filing instructions. FILFn-
I (We) 6A 13 / cf AJUICA
certify th on the 1st day of rrh, 20
1 (We) occupied as our principal place of residence the following described real property for which . Homestead Mebyd ad-
y ci
El I (We) owned ❑ Are buying under contract GIBBON ea
AUDITOR
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 contra d.
NT"crzRIECORDIED
If buying an contract. Fee Simple mvnees name
Recorder's office where contract is recorded Record number Page
OWN Y..
UE,
County
A,5 0C
Tomshlp
Taring Isl(city, town, ftVi i)
Parcel number
description
Is the mapertyin uestion:
eF —00
We Wp\'�-) 1� 1-ib 3 . 4'dtt�
WR," property ❑ Mobile
fiery portion of the residential structure or the land not exceeding me (1) am that Immediately surrounds that structure is used to produce income, describe the use and portion
of the prop" util¢ed to produce Income-
OWN Y..
UE,
County
Tmnship
County ---Jio;;nship
I hereby certify the above statements are true, correct and complete.
Signature of clairriant
,ALdress (number and sheet, city, state, ZIP code) U
AD,( elh 4 46(71 e A/ q 7& q C old Ale-I 5 5
OWN Y..
UE,
XgisffiD
VOMESTE.Affi)-L
� W�N 0 N 9 Eit 'DE i FtA:L- &�,
100%70ET rV
'= li,
-- -'
. CAN
Land not exceeding I (one) acre immediately
rp
surrounding residential Improvements.
(1)
WNW
Other land
(2)
Trial land (line I plus line 2)
(3)
Dwelling
(4)
WN I
Residential improvements
Garage
(5)
m@
W
Other improvements
(6)
WOM-11 IBM
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(8)
I hereby certify the above Is true, correct. and
Signature ofAssessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
e
. . . . . . . . . .
I
IJARIJ.DEDucTioN,AL LIDWANCE
20 Pay 20 _
Lesser of 1/2 Homestead
Valuation or $6,000 $
Signature of Auditor Date signed