Homestead_BalesCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
" CREDIT /STANDARD DEDUCTION HCto
t - / State Form 5473 (RS / 10-01)
°M Prescribed by the Department of Local Govemment Finance �j "�
INSTRUCT ONS: See reverse side forfiling instructions. ICJ I I �--�
-v- . ' F z- I f�iy5", 1. •CER FI ON STATEM r r3r' '` '-u N
daaay 2003
I (We) certify tha onAthe 1st 20 of
1 (We) occupied as r principal place of residence the following described real property for which a Homestead'P Tax Credit i�hereby of imed:
/7operty
❑ I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for t;�l n
the property y taxes on the property and that owns the property n g under a contract.
NTRACT_ RECORDED„ y.."¢ ?, rr '"'„y.r'�°"°'''"'.'3'c„'.'' -.z'
-- -
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded
Record number
Page
- -
PERTYDESCRIP ,TION.'_'iY;s- v*'g'.
County
hereby certify the above statements are true, correct and complete.
Township
mu (number and street, city, state, ZIP code)
RR I 13o 3116 r e%ce idll TN q7L 7 0
Taring district (city, town, row i
Parcel number S ^ (0�
e
ao {b /7-J-//
2V f-rnReal
S �i'NON tESfDENTIAL
��:t VALUE:
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ir/Jesid`
(1)T-
property ❑ Mobile Home (I.C. bf.
- ''`�Giyi -r
8 any portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds rhartt structure is used to produce income, describe the use and portion
of the property utilized to produce income.
- -
a-
County Township
County Township
hereby certify the above statements are true, correct and complete.
S� igpalure o an <
mu (number and street, city, state, ZIP code)
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ASSESSORIUSE ONLYe' of "y,.+',
��`: s$X'.i�'.. _ .•LiCCe-
TRUETAX --'
VALUE;
1�1..,-�.. - .c1.-
ASSESSED VALl1E
"AT 100 %OFTfV
._ rrr�.�..
HOMESTEAD
VALUEf +�'
iT. A -. Ta
S �i'NON tESfDENTIAL
��:t VALUE:
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)T-
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Other land
(2).
,.` ".'
°.
Total land (line 1 plus line 2)
(3)
Residential improvements
Dwelling
(4)
I
Garage
(8)
sI s
Other improvements
(6)NE�v?"
Total improvements improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed