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Homestead_BedwellCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (F5 I I0.01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing Instructions.
FORM YEAR
HC10
L - -D
(we) ce on the 1,t day of March, 20
1
I (We) occupied as our inclipal piece of residence the following cibed real prpetyfar which aHoV �teadjProperjyjTaUr edit is, perel'claimed:
OCCUP as 0" r7 p
❑ I (W1.) cw,..d ❑ A Are buying under Contract L
R
'JRC�Ot4 Cot
Have a beneficial interest in the entity that is liable for the property taxes on the property and that ownsqQ9.N COIJ,- 0
a .pertly or is buying under a contract.
V �,J�'OfW 'i'-CO NT RACT-A ECO RDEW '!i!= i.ka
If buying on contract, Fee Simple owner's name
Recorders office where Contract is recorded Record number Page
P -ERTYDES1CR[PT1
ROO,
Coun
Township
Township
Taxing district (city. toivtohip)
Pa I in r
Legal it Is the ropeny in Question:
on: X
Sig of Claimant
n
7511 NE � —3 — 101 ljl,)o Ar NReal property El While Home (W. 6"1. 14)
If any 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 th ti dr
�—e I . -'Nt—z
V4
County
Township
'HCI-MESTEAD�72'
County Township
I hereby certify the above statements are true, Correct and complete.
S
Sig of Claimant
n
W �(8num� ber
R Lb
IN 4 7(
�—e I . -'Nt—z
V4
_2�-rjRl.1E-,TAX0 -14
'HCI-MESTEAD�72'
NON�ftESIDENTMV , W,�
I W-1,11
0�t.VALU E
V-- A -F4
Land not exceeding 1 (one) acre immediately
S
re of
ditor
Dale ?*j��_
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
.—W
Q :&
Residential improvements
Garage
(5)
Other improvements
(6)
A AN
Total improvements (line 4 through line 6)
(7)
Tdal value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TAIN16ARIDIZEDUCTIONALLOWANCIEf
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $6,000
S
re of
ditor
Dale ?*j��_