HomeMy WebLinkAboutHomestead_Bullock (2)CLAIWFOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
.1
FORM
HC10 I
YEAR
I (We) rye certify that on the 1st day of March, 20_
I(W.e) occupied ��rhp4n�lplace of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
�Kl (We) owned ❑ Are buying under contract
O—R
save a beneficial interest in the entity that is liable for the property taxes an the property and that owns the property or is buying under a contract.
'-"3,,CONTRACT-RECORDEDa',�,-'-�-3r�,:�-,�7-"�,-
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
P,�*��-,VWA,T�V4.-, "_,?t"te0l"i ',.t.�. PROP�ERT7.YOWNED'BY,CLAIMANfjW.OTHEFt-COUNTIESzVi6 ,�4,.� '4�
County
County
Township
Township
Taxing 'strict (city, to", township)
Parcel number
Legal description
Is the property in question:
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51iaD Me, X
— 3— 1?
.2:11tal property ❑ Mobile Home (I.C. 61.1-7)
If any portion of the residential structure or the land not exceeding we acjB thit immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce Income.
-5,
�Do
51- A ?- tea- 06 </
j V/- 4Q
P,�*��-,VWA,T�V4.-, "_,?t"te0l"i ',.t.�. PROP�ERT7.YOWNED'BY,CLAIMANfjW.OTHEFt-COUNTIESzVi6 ,�4,.� '4�
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Adillp&s (number and street, city, state, ZIP code)
"STANDARD DEDUCTION 'ALLOWANCE:,
4!kki; 1,
ASSESSED
H-OME'S-TE-AD , .�,
'NON RESIDENTIAL
z�-j `"VALUE
Land not exceeding I (one) acre immediately
surrounding residential Improvements.
(1)
?NOV
Other land
(2)
;u
Signature of Auditor
Total land (line I plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
(4)
Garage
(5)
,911er improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct. and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
"STANDARD DEDUCTION 'ALLOWANCE:,
20 _ Pay 20
Lesser of 12 Homestead
$
Valuation or 535,000
Signature of Auditor
Date signed