Homestead_Byrns (2)CLAIM FOR HOMESTEAD PROPERTY TAX F M Y R
>4- CREDi FSTANDARD DEDUCTION
Slate Form 5473 (R817 -07) HCt
•� rsn Prescribed try the Department of Local Government Finance 6 200
INSTRUCTIONS: See reverse side for riling instructions.
I (We) certify that on the 1st day of March, 20
t (We) occupied as our principal Vace of residence the following described 41 property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
If buying on contract, Fee Simple owner's name
Recorders office where wntract is recorded I Record number Page
County I Township I Taxing
Parcel number Lega descdpVon —� I Is the property in question:
eal property ❑ Mobile Home (IC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1) acre the ion lately surrounds that ture is used to produce income, describe the use and porton
of the property utilized to produce income. / •i'iaG
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
-
Other land
(2)
Total land (line 1 plus line 2)
(3)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
(4)
Garage
(g)
- - -
..
Other improvements
(6)
-
Trtal improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed (month. day, year)
Verifying action - Signature of Auditor
Date signed (month, day, year)