HomeMy WebLinkAboutHomestead_Deal (10)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R5 / 10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
V CE!&CATION STATEMENT' P
I (We) ub L) certify that on thdAfti,� of-N1 W20
I (We) occupied as oVT principal place of residence the following described real property for which a Homestead PrcHjeFfty Tax Credit is hereby claimed:
�1 (We) owned ❑ Are buying under contract
�aave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propeqXq�buy-in'g" tt-ndei,486-nfira-ct.
' CONTRACT!RECORDEDI�ej,3
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
W- ::PRO0.EkTY.1j
dRio, 6 � I.—, �� "
ES -TI W��
County
T ship
I hereby certify the above statements are true, correct and complete.
I
Tatting district (city, for ip)
'cress (number and 1, city, state, ZIP code) t
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�t�r�EV
A'. j f��-VALU E.1 jk
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Legal description
.
Is the Property in question
1 J2- �el property UO Wbile Home (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 structure is used to Produce income. describe the use and portion
of the property utilized to produce income.
Ala a
0 "q
K VERTYIDWNE67BY CEAlK04WTIkbTHEk-COUhT1EES •
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
I
SiwWure of claimant
Z.AA�, Z.0qL—)Q,0.A
'cress (number and 1, city, state, ZIP code) t
-100%-1100%-OFJTV�
&t�ASSESSOWU SE ONLY
--A--TRLIEtTAX�"- A
'AS
lj-�H-O—MESTEA-D-'�
-RESIDENTIAL` 4iv--,
Valuation or $6,000
4
VALUE;
-100%-1100%-OFJTV�
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A'. j f��-VALU E.1 jk
a,�n
,,ALUE
.
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
z, ZE
'T Jti
Total land (line I plus line 2)
(3)
Dwelling
(4)
Residential improvements
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 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
STANDARD)DEDUCTIONALLOWANCE
20_ Pay 2O_
Lesser of 112 Homestead
Valuation or $6,000
4
A FS
Signature of Auditor
Dal ifine(Y4,