Homestead_Cullom" CLAIM FOR HOMESTEAD PROPERTY TAX EAR
CREDIT /STANDARD DEDUCTION Hcto
Sate Form 5473 IRS 17 -07) rr71
. Prescribed by the Department of Local Government Finance 009
INSTRUCTIONS: See reverse side for filing instructions. �.- _ .1
I (We ) aA-� certify that on the 1st day of March, 20
I (We) occupied as #r principal place of residence the following described real pmperty 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.
CONTRACT • -. .
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
County
PROPERTY
TOxrnsNP IW,2rg district (city, town, tormship)
Parcel number
L al description / y- �+G
the pr in question:
45,000 for 2007 pay 2008
SE /7-
(la
❑ Real pmperty ❑ Mobile Home (IC 61.1 -7)
If any portion of the residential structure m the land not exceeding one (1) ave that immediatey surrounds that structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
,,1(c- /1 -r'7 -q6o- oo /- Ggo -oxI
ASSESSOR USE ONLY
i
TRUE, TAX VALUE
ASSESSED VALUE
HOMESTEAD
NON-RESIDENTIAL
45,000 for 2007 pay 2008
42,000 for 2010 pay 2011
AT 100% .
Lesser
Homestee ad d Valua tion
44.000 for 2008 pay 2009
Land not exceeding lone) acre imrtediatety
$
cr
43,000 for 2009 pay 2010
-
surrounding residentlalimpmvements.
Sigingiture of Auditor
s
Other land
Tdal land (line 1 plus Me 2)
(3)
Dwelling
(4)
Residential improvements or Annually
�41A
Assessed Mottle I Manufactured Home
Garage
9
(5)
.. -
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(8)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Date signed (month. day. year)
STANDARD DEDUCTION
cJ _ pay 20 _
45,000 for 2007 pay 2008
42,000 for 2010 pay 2011
Lesser
Homestee ad d Valua tion
44.000 for 2008 pay 2009
41,000 for 2011 pay 2012
$
cr
43,000 for 2009 pay 2010
40,000 payable after 2012
Sigingiture of Auditor
Date signed (month, day, year)