HomeMy WebLinkAboutHomestead_ChristmasCLAIM FOR HOMESTEAD PROPERTY TAX �G FORM
CREDIT /STANDARD DEDUCTION Hc�o
State Form 5173 (De Department Prescribed by dro Department d Local Government Fmarn>!
INSTRUCTIONS: See re`vrae ouch Mr JEhg er66tal f*=
YEAR
I (We) certify that on the 1st day of March, 20
I (We) occupied as our principal place of residence the following 16escnbe6 real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
QHave 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.
.a_xn• =� �.- 'Y5W.'S -u - q` •r• 4 �. CONTRACT_ =RECORDEO'a., „•:xi',:,.,t- SSFy.n -'_r , 3' „n""'w,; .,^,�:'x”
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
xq-W
z .,sx�t ,1 -DEer o- , . PROPERTY: CRIPTION�r y
County
Tonnship
Taring distric city town, townshi )
Parcel number
I qual description
Is the property in question:
U -
'1
—� -
eal property ❑ Mobile Homo (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds tha tructure is used to produce income, describe the use and portion
of the property uWized to produce income. I —a 3 �+
7 CZhCcQ c96- /0 - ,;A5 -dCO co C5. d -aw
P,RO.- .a " 3. G . �'4 -•- J
P.ERTYOWNED16Y CLAIMANT;IN: OTHER' COUNTIES. t�g
County
Tmnship .
County Township
I hereby certify the above statements are We, correct and complete.
`S" ure of claim =
\ L
Addresssmber and street, city, stater ZIP code)
r).
p" 1r�r>- .TRUE;TAI(
yASSESSORIUSE ONLY
-
ASSESSEDVAL.UEHOMESTEAI)
`w `
xNON;RESIDENTUIL -+
��a-r
r't.�
.kYt?m. %s`,t44= S- sYii3..- •e'ry„X,,.�a
'�' VANE
AT 100 %OF'TTV
VALUEr 'eT
`" "'VALUE""
�t-S ..�iw`L`a�
Land not exceeding 1 (one) acre immediately
Sign of AWitor
surrounding residential improvements.
Datesp i
Other land
(2)
a
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'Residential Improvements or Annually
f. a.vhMy
Afaeafed MobOe/ Manufacofred Hama
Garage
6
()
h <, _
2r :1 W. .
� l� y
Other improvements
(6)
¢j
g' ;.
Tdal improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(S)
1 hereby certify the above is true, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
DARDDEDUCTION'ALLOWANCE''r2
_ 20 _ Pay 20
Lesser of 112 Homestead
IS
Vauaaon or S35.D00
Sign of AWitor
Datesp i
1 �l