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CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y AR
CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (Re / 4-03)
Prescribed by the Department of Local Government Finance
YgTRUCTIONS: See revem e11Y0 Ilr MV ilsbucdom
e • 6�Y.JV u2/ ! �—� - certify thaibn theUls ( ar
o led as our principal place of residence the following described real property for which a Homestead Property Tax Credit is here y d
I (We) owned ❑ Are buying under contract JAN 1 0 2006
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property ris buying under a contract.
If buying on contract, Fee Simple owners name
Recorders office where contract
Record number I Page
s
County Township
Taxing disuicn ry, to , t ru ip)
r 1 u STe / I descnption
(/
s the in glG3�ea I prof ❑ Mobile Homo ( /.C. 6-1 -1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property utilized to produce income.
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County Torn s h i
County T ip
QHOMESTEADD.A
gN AESIDENTIAL
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I hereby certify the above statements are true, correct and complete.
Signatu of claimant
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dtimspinumber sV,yaVe /jt/cV, s�tarte, ZIIPpo e))
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ASSESSOR USE ONLY..``"
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ASSESSEDVALUE
QHOMESTEADD.A
gN AESIDENTIAL
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s n VALUE
%OF�.TNiVALUE't
r
n VALUE- s��`r"
Land not exceeding 1 (one) acre immediately
-Is
surrounding residential improvements.
F
F .I. Y -„* -+�14 ,
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential Improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
F Si"<
f"„ s `..' ->
:�v_� -.
Other improvements
(6)
T y3
� .' S• f
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
C= STANDARD DEDUCTION'ALLOWANCE,"
20_Pay 20_
Lesser of 112 Homestead
vauatron or 535.000
$
Signature of Auditor - Date sgny�`� Q�