Homestead_Barrett (7)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HC10
t State Forth 5473 (R5/ 1001)
4r Prescribed
by the Department of Local Government finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) certify that on the 1st day of March, 20_
(We) pe upied as our principal place of re 'dente the following described real property for whtch a Homestead Property Tat Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contrail
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.
NTRACT' RECORDEDTrr": +.',,%�Su'o'..M.:.,``.'c�7.'.s_
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
_�_
°=• r >BES O USE M1ON�LY,
RTY :OESCRIPTIONT''.si`.t
County
Township
County Township
Taring d' (city, town, townshi )
Parcel number '' \\
Legal description
Is the pmperty,in�que /stpn:
V
V
Li•Real property ❑ Mobile Home (I.C. 8-1.1-7).
If my portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
surrounding residential improvements.
� 30- 11
�,OOa.�•
-
Other land
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°=• r >BES O USE M1ON�LY,
UETAX
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant .
Aegress (number and street, city, state, ZIP code)
_�_
°=• r >BES O USE M1ON�LY,
UETAX
ASSESSED VALUE
�H061ESTEADT'
pNONR SIDENTIALWr
s VALUE'
. AT ;10096- OFTT\!�VALUEVALUE
Land not exceeding 1 (one) acre immediately
(1)'`%:
U�t.`s£'' ' -
surrounding residential improvements.
<:-. ter'..`' _�
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)'`��T.'
-1'j
-
Residential improvements'
Garage
?
(5)
„ff3s_sC,
Other improvements
(6)
Trial improvements (fine 4 through line 6)
(7)
Tclel value (line 3 plus line 7)
(6)
hereby certify the above Is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
(V (''�, j — *. i>i+�iv�- {3f�.:]!f K :: Y. y[• aT�-�, YA
20 Pay 20_
Lesser of 112 Homestead
Valuation or $6,000 $
Signature of Auditor Date signed