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Homestead_Clarkrj
CLAIM FOR HOMESTEAD PROPERTY TAX FORM �� YEAR _
CREDIT /STANDARD DEDUCTION
State Forth 5473 (R614-03) U
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing inshuUions.
I (We) 1491 -YP fl� I 011114LC.(1 ` zl ( <J �/.%� /i It,/ certify that on the 1st day of March, 20_
1 (We) occupied as our principal place of residence the following described real property for which a Homestead PrifpEq T# Lreo@t pereby claimed:
(We) owned ❑ Are buying under contract
Have a beneficial interest in the enflty that is liable for the property taxes on the property and that owns the pr4�fj7,pfjs WM(Lunder a contract.
. ��' W�`�•oz.:.rY-�i;:���,;CONTRACT. °RECORDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
.F.1�fK"..�K` '' T' —.�P.ERT.Y<OESCRIPTION. =,�= 3',` i> . ?z---
P,RO
County
Tavnship
T mg
lri I (city, town township)
Parcel number
Leg de 'piton
I Is the propel in question:
— O — !)
' tr" Yy'W,
l property ❑ Mobile Homo (LC. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately su
of the property udtaed to produce income.
unds that structure is used to produce income, describe the use and portion
'+YASSESSORUSE ONLY =
4.,sa9 .z�1£1:�.F �.s
County
Township
County Tavnship
hereby certify the above statements are We, correct and complete.
Signat re of claimant
tlress (number and treat,,.ciity, state, ZIP code)
!Q10 Lj
'+YASSESSORUSE ONLY =
4.,sa9 .z�1£1:�.F �.s
"--TRUE -TAX
ASSESSED VALUE
AT -700% ff.M
HOMESTEAD
W— VAL'UEf' 0
f NONgRESI�ENTIAL z
Z "A.. LnLRU w.
Land not exceeding 1 (one) acre immediately
' tr" Yy'W,
surrounding residential improvements.
Other land '
(2)
j „•X
Total land (line 1 plus line 2)
(3)
Dwelling
(4)"`.":�.-
`' ?`: ti•
Residential improvements or Annually
-#-
-'''
Assessed Mobile I Manufactured Home
Garage
�Q.
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Trial value (line 3 plus line 7)
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
�rf�;y1t`STANDARU DEDUCTIONALLOWANCE; i;s„ �� <:'e ".`'...'1"t�-- ''`,;.`y.`"x,
20_Pay 20_
Lesser of 112 Homestead
vauabon or 835.000
$
Signature of Auditor Date signed