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Homestead_Dearing (4)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5.473 (R614-03)
Prescribed by the Department of Local Government Finance.
INSTRUCTIONS: See reverse side for filing insfrucGons.
.r"� a? ! CERTIFICATION STATEMENTirr�',! � n •- ?- `?s�•f•.jc* 'e'ay,.i.f3 .g -
1 (We) certify that on the 1st day of March, 20
I (W/ occupied as our principal place of re enco the following described property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract
0 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.
.F�. CONTRACT' RECORDED A h T
::.'e'& ".�Et�`Z`J•sRa +"3.�' >�r'�3 _-`#.,�r�:��'f :•q.� .I n`�. "'�Z'? rtzr•- w�F�.'�''V.Ta�'` *�+6'.�;�'" `n�..�
If buying on contract, Fee Simplo owners name
Recordees office where contract is recorded Record number Page
4+"'',ki ? 't Rs"`.5_?- ?-'.°Y:i '-'r
r' a � `P,ROPERT.Y DESCRIPTION t �_ _ i F i-' t :? -'r -r"-• - . v^r_�•: .t. = `. o .�,Y.�
County
Township
Taxing oistnt (city, town, township)
Parcel number
Le description
I
Is the property uestion :
Zeal
Date signed
/
property ❑ Mobile Homo (I. C. 6.1.1 -7)
If any portion of the residential structure or the d 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.
'
Yl 7oP A2.L
(3)
County
hereby certify the above statements are We, correct and complete.
Address (number and street, city, state, ZIP code)
County
Signature of claimant
SSES OWUS � �=
v ASSESSOR�USE ON'Y- ^
k -,• _- „�,K_.•;t:' ,F_- ht.,:.
=" TRUETAX
'',F,VALUE_n -y v:
att_
ASSESSED VALUE
z`' °_'
AT100A
HOMESTEAD'S
w
" ANON= RESIDENTU\L �'` ?
+: s
EM MA, �c -. M
°t<G Lr�f`i,.a ...- ,.csks.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
Signature
Date signed
x
Other land
2
'
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5 ),Y�''�t°
Other improvements
(6)r's-,_,
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plrs line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
- - .ceie... -_ ifs I L s;3 y =s. Z✓ , f¢ r'^ ""n
,�...rr3r*.s€3i` o�=`. :.STANDARD'DEDUCTION'ALLOWANCEa
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535.000
$
Signature
Date signed