Homestead_Edwards,} CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R6 14-03)
Prescribed by the Department of Local Gmemment Finance
INSTRUCTIONS: See reverse side for fifing instructions.
I(We)
FORM YEAR
HC10
the 1st day of March, 20
(We) occupied as V 6pr principal place of residence the following rl / scribed real property for which a Homestead Property Tae Credit is hereby claimed:
El (We) owned El Are buying under contract i/�^ ^~
GtBSOi' r
lk 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.
tlr .sy..�
... �' ?�,.�n'.�z��,(•,a;'�`�"w�,�`xYs ONTRACT;RECORDEDS�. ��tt� s'�.�,z n'�a��*a_.. �•:c?` �•�,�a1_r;
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
sl <p+x .� - -—.en sr9'
.'�,r::r�a �,r. ,.a..a- ".�'a.:rry
-taws
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..c`�—z:3P, ROPERTY :DESCRIPTIO073r`y?'s= �i. -3?
County
Township
Taring district (dry, town, township)
Address umberandstree state ZlP COda)
n o
Patecel number
Le
s
'on
Is the property in question:
—1
`+� NONWESIOENTIAL n
o VALUE% -�''"
fi u �. -..s. ..,,. s:.�1. I
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
3° Real property
❑ Mobge Homo (LC. 6- 1.1 -7)
If any portion of the residential structure or the lad not exceeding on (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
Of the property utilized to produce income.
'5�'G -
4d - .y-'QW
20_Pay20_
Lesser of 1A2 Homestead
Valuation or 535.000
Signature of Auditor
I . -As -ra
County
Township
County Township
hereby certify the above statements are We, correct and complete.
Sig tune of daimaP
,-I//
Address umberandstree state ZlP COda)
n o
4FA�' ASSESSOR USE ONLY
x �i • zt"YR�- v,,:;ya;gf: �,x','- +"��'. „st, - ,4.,;y
r
VALUE 3:,r;
ASSESSED VALUE
AT 100 %OF TSTV
HOMESTEAD
r,�
,s• . cVALUE._;
`+� NONWESIOENTIAL n
o VALUE% -�''"
fi u �. -..s. ..,,. s:.�1. I
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually'
Assessed Mobile I Manufactured Home
Dwelling
Garage
(4)
(5)
` G
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Dale signed
20_Pay20_
Lesser of 1A2 Homestead
Valuation or 535.000
Signature of Auditor
I . -As -ra