Homestead_DaileyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
♦ State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for fithig irjstruclirms.
FORM
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I (We) U 11&41 -V ..-i 3f��— Ak �U I 0 ' certify that on the 1st day of March, 20
1 (We) occupied as our principal place of residence the following described real poperty for which Homestead Proy�JCk"- hereby claimed:
❑ El
I (We) owned Are buying under contract W-AMUON COUNTY
AUDIT
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 un pq contract.
CONTRACT. RECORDED
If buying on contract. Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
PROPERTY DESCRIPTION! -t. ,
County
Township
Taxing district (city, to", township)
Parcel number
Legal description
Is the property in question:
dress (number and street, city, state, ZIP code L47 (fi t-,!5
VALUE-
ILI
Real property ❑ Mobile Homo (I.C. 6. 1. 1-7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that ?0cerre is used to produce income. describe the use and Portion
of the property utilized to produce income.
co -. -C9 -
'r - r�:� 4 -
';��.li'OkOPEkTY.6WNEbBYCLAIMAkTii4.-OTHERdOUkTIES7-'�'t'
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature aimant
dress (number and street, city, state, ZIP code L47 (fi t-,!5
11111111fil
r .!,. - - - - . - .., a r :. '. . : -
. . -STANDARDMEDUCTION ALLOWANCE,
20 Pay 20
ASSESSED VALUE
Lesser of 112 Homestead
NON-RESIDENTIAL
--,ASSESSOR USE ONLY..
"u,
_TRUETAX
AL
VALUE.
AT 100% -OF--nV -
VALUE-
ILI
':-' :VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
.. ....
Y 1, �Iv
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
1 (7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
r .!,. - - - - . - .., a r :. '. . : -
. . -STANDARDMEDUCTION ALLOWANCE,
20 Pay 20
Lesser of 112 Homestead
vaivation or 535.000
Signature of Auditor