Homestead_BrigglerCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
J State Form 5473 (RS / 10.01)
Prescribed try the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
HC10 0--210
(W - ce fig a n e 1st y f rch 0
I (We) occupied as our principal place of residence the followi "bed real property for which a Homestead Property re daimed
❑ 1 (We) owned ❑ Are buying under contract MAY 10 202
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns tpe,properfy or is buying under a contract.
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded
Record number I Page
: �� '.Y��3,7,,se'i�- `.�'��,z�:'�a� ��t�it'' w: �.,. s.:? P, ROP, ERT, YUESCRIPTION ...-- w�'�?�?�'•;•f'..GN a.'�u'�`�.,�r' �; ��� :i��''t><y.•"��a�f_°��h`�:.��`
Coon
Township
Tai n dis ' town, town hip)
cel n r
O—iJT � —�
L d /n-
�t� --�"��
Is th props i qu on:
%.OF TTY
w �.1 �-/
eal property ❑ Mobile Homell.C. 61.1 -7)
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 the property utilized to produce income.
�
PROP,ERTX, OWNED ;BYCI'AIMANT;INATHER'COUNTIES
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
ignature of aimant
LdAess (num er and street, " , state, Zip code) D" Q3 0 �..l.�sl " """'�^^'L (.0 (0
�". j� SONLYF
TRUE TAX4
t'"ATa100
ASSESSED VALUE
r'HOMESTEADi
'""'" NON RESIDENTIAL
AASSSD
yALUE-
%.OF TTY
.e VALUE.
°53C: VALUEx-
Land not exceeding 1 (one) acre immediately
(1)
surrounding residential improvements.
%?:,€y'n.T
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
yyi,,
T£i'aM4YV j
rig I tkr s
= .'fi1'.diru.n'..
Residential improvements
Garage
(6)
4 i
Other improvements
(6)
; r'$
'4.3 �TMr'.,�'mvr
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
. 'mac `c'a'F
�„ �.,,.,, ��`' �, �# c>„- t?;'3 �, fi�,' �r�..'' STANDARDDEDUCTION7ALLOWANCEts. ?• a�.?ar,°^,4`..:.>yEi„v'�¢.m�."�
20 Pay 20_
Lesser of 112 Homestead
$
V nation or $6,000
Sign at a o ditar
Date signed �/v O