HomeMy WebLinkAboutHomestead_Davis (11)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Fomi 5473 (R6 / 4-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS., See reverse side for riling instructions.
FORM YEAR
HC10
I (we) I le certify that on the 1 at day of March, 20
(We) pled as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
-opou
-11 e) owned ❑ Are buying under contract
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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. RECORDED-':'-
If buying on contract, Fear Simple owners name
Recorder's office where, contract is recorded Record number Page
PROPERTY.D
County
Township
Taxing district Gdy, to". town hi,
I I n 911-a
ParSell number
Legal description
Is the property In quesilon:
-1100W
AT-1100WOEXTVv
1,1A a IQ-3-1
I E) Real property ❑ Mobile Home (i.C. 6.1.1-7)
It any portion of the residential structure or the land For exceeding we (1) am that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. 9.5('0
aw -". 1,3 5—'-" e7a
PROPERTybWNED'By.'cLojm4NT-.tN
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
aresis (number and street city, state, ZIP code)
-P
' - - -- , z- ��-z
TRUE TAX
, AS Wiftk
A'
kkdioikiTL46�
-
ASSESSOKUSEONLY-:,��
-1100W
AT-1100WOEXTVv
-;;,VALUE
Signature of Auditor
Date ' ned
Land not exceediRg I (one) acre immediately
V- L - C)
surrounding residential Improvements.
Other land
(2)
Total land (line I plus fine 2)
(3)
Dwelling
(4)
q
Residential improvements or Annually
kA
Assessed Mobile Manufactured Home
Garage
(5)
O�her improvements
(6)
Total Improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct. and
Signature of Assessor
Date signed
complete.
Vanlying action - Signature of Auditor
Date signed
tW,�4,, --�ri�,��-P4t-STANDARD DEDUCTION' ALLOWANCE P.-
20 _ Pay 20
Lesser of 1/2 Homestead
Valuation or $35,000
Signature of Auditor
Date ' ned
V- L - C)