No preview available
Homestead_BirkCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT /STANDARD DEDUCTION State Form 5473 (R51 10-01) Prescribed by the Department of Local Government Finance INSTRUCTIONS: See reverse side for riling instructions. . [I 1/'1 - FORM V� YEAR I I d*D1 1 (we) Is.4 - A&8IC4 3r- t�_ - �Xtj4e44�Lhat On* s()[1y TOV, 20 1 (We) occupied as our principal place cr[I;&O� e the fioll;,A3de I "c y fo�whtch a Homestead Property Tax Credit is hereby claimed: ❑ 1 (We) owned ❑ Are buy' 7un-dee, contract 1W ct.ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns t r C N djo t, igt&nd6r'6U hfl� BS N 01-N-1 , AUDITOR I ,-,'yb,lP-����-tONTRACT'RECORDED-4��-- If buying on contract, Fee Simple owner's name Recorders of where contract is recorded Record number Page OR60-ERTY, DESC RfRTION I3W:s r4jr County Township Township Taxing district (city, town, township) pan r cription enq be street, ale, ZIPc e f4�) 1,4 Is the property in question: 5f: W 1 ❑ Real property ❑ Mobile Homo (I.C. 6-1.1-7) If any portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds that structure is used 0 produce income, describe the use and portion of the prop" utilized to produce income. surrounding residential Improvements. C411 -/ PROKEk1*6WNE6B? CLklMA-WT.fN6TFiEk'"&(5LfkTIES�I -TRUE TAX' aj County Township I County Township I hereby certify the above statements are true, correct and complete. igna ure of claimant enq be street, ale, ZIPc e f4�) 1,4 I - - - - I I - * - — I — — 3 ul AMM& S1' NLN�- -TRUE TAX' aj ASSESSED -.VALUE _!HOMESTEAD�9. -RESIDENTIA �NON� ,:tT .f ;j.Z�ftf , W U La Land not exceeding 1 (one) acre immediately surrounding residential Improvements. Other land (2) Total land (fine I plus line 2) (3) Dwelling (4) Residential improvements t;t Z.� Garage (5) ge Other improvements (6) Total improvements (line 4 through line 6) (7) Total value (line 3 plus line 7) (8) 1 hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed 20 _ Pay 20 _ Lesser of 112 Homestead Valuation or $6.000 Signature of Auditor S I , ,