Homestead_Brown (4)CLAIM ;FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R6 / 4-03)
Prescribed try the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing Instructions.
YEAR
I (We) certify that on the I at day of March, 20
I (we) occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit Is hereby claimed:
011 1 (We) owned ❑ Are buying under contract
*1 ave a beneficial interest in the amity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
X,.;`4,--6.,&CONTRACT, REC ORD ED jt1z "' �; -. �. ... � , I f - . -- � .� .
If buying on contract, Fes, Simple owners name
Recorder's office where contract is recorded Record number Page
-
�i5,t��w 9M���PkOPERT�Y-I)ESCRIPTION�,k.-�.�-,',
County
Township
T I district (city to, township) 1 7 di � (city
number
Legal description
Is the property in q —
uestion:
n 6-0396.-I-co
1A 550 R, -3 -12
11%rr�
1 je:2-Real property ❑ Mobile Home (J.C. 6-1.1-7)
It any portion of the residential structure or the land not exceeding we (1) acre that immediately surrounds thotructure is used to Produce income, descibe the use and portion
of the property utilized to produce income.
Date signed
-Ala - 560- el03.
C), —)7
MM �= PROP,tFtT4V:OWNED,$Y,'Ci�fidMKNT,'IWO"EFC,tOUNnES',
� -1 t;_ W- 4Wt
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
W(number and street city, state, ZIP code)
IM z
B M �ASSESS-fO� W SE,
ON
"-M*-
4�TRUE TAX
i
ASSESSED fJ-
%t HOMESTEAD,,
zZ -,f-RESIDENTIAL-l�''.,
l"M k
7W a 1�� ,
�VAL
Ss
Land not exceeding 1 (one) acre immediately
Signature of Auditor
Date signed
C), —)7
surrounding residential Improvements.
-174v
1 A
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
866
"' Fm
-
improvements
(6)
,?*t
Total improvements (fine 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signaftim of Auditor
Date signed
STANDARD, DEDUCTION' ALLOWANCE
20 _ Pay 20 —Fs
Lesser of 112 Homestead
Valuation or 535,000
Signature of Auditor
Date signed
C), —)7