HomeMy WebLinkAboutHomestead_CallisCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
` Stale Form 5473 (R617 -07)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
Ftt FORM
HC10
AFB 0
YEAR
I (We) —t!L 10 y1 a rn `— eQ Vi , n V �� r y 4(r� certify that on the 1 st day of March, 20_
1 (We) occupied as our principal place of residence the following described real property for which a HoiI 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.
CONTRACT •-r .
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Paga
PROPERTY .
County Township Taxing district ( y, to- ship)
Parcel number Legal description Is the property in question:
❑ Real property ❑ Mobile Home (IC 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that sbucWre is used to produce income, describe the use and portion
of the property utilized to produce income.
alp - l� - 5Q H00 -Lvoo. a a -oaj
ASSESSOR USE ONLY
TRUE TAX VALUE
PROPERTY OWNED BY
County Tavnship
County Township
I hereby certify the above statements are true, correct and complete.
Slila of claimant
' "ress (number and street city, state, and ZIPcode)
ASSESSOR USE ONLY
TRUE TAX VALUE
ASSESSED VALUE
HOMESTEAD.
NON-RESIDENTIAL.
45,000 for 2007 pay 2008
42,000 for 2010 pay 2011
I AT 100% 6F TTv
VALUE
VALUE
Land not exceeding 1 (one) acre immediately
S
or
43,000 for 2009 pay 2010
40,000 payable after 2012
surrounding residential improvements.
Signature of Auditor
Date signed (month, day, year)
Other land
Trial land (line 1 plus tine 2)
(3)
Dwelling
(4)
Residential improvements or Annually
f
Assessed Mobile / Manufactured Home
Garage
5
O
Other improvements
(6)
Total improvements (fine 4 through One 6)
(7)
Total value (line 3 plus fine 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month, day ymr)
pay 20—
45,000 for 2007 pay 2008
42,000 for 2010 pay 2011
Lesser of 1/2
Homestead Valuation
44,000 for 2008 pay 2009
41,000 for 2011 pay 2012
S
or
43,000 for 2009 pay 2010
40,000 payable after 2012
Signature of Auditor
Date signed (month, day, year)