HomeMy WebLinkAboutHomestead_Creek (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 IRS 1403)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for riling instructions.
I (We) W
I (We) occupied as our p ' pal place of residence the following described
(We) owned ❑ Are buying under contract
FORM 1 YEAR
HC10
-d2-4 certify that on the 1 st day of March, 20_
for which a Homestead Property Tax Credit is hereby claimed:
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.
eCONTRACT;RECOR_DED's
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
P,ROP,ERT,Y<OESCRIP.TION'
County
Township
Taxing district (city, town, township)
Parcel number
L I descri don c
k) S
Is the property in question:
-
S e
❑ Real property ❑ Mobile Homo (I.C. 6- 1.1 -7)
H 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 udlized to produce income.
3-77,5
PROP .ERTY- OWNEDaY CLAIMANT
County Township
County Txxvnship
I hereby certify the above statements are true, correct and complete.
Signature of claimant
Address (number and street, city, ware ZIP code)
fa-' ES OR SE ONLY
r TRUE TAX ''ASSESSED
VAL:UEa
___
VALUE
OF.Trv�VALUEVAL'UE.,
.: -...ter ...._...
HOMESTEAD -
NON RESfDENTVIL - ' r
- _ .:
Jw
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
"%I°
W
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
4 .
'Residential improvements or Annually
_o # . r
�
Assessed Mobile I Manufactured Home
Garage
(5)
�') ;
Other improvements
(g)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line %)
(S)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
$E°.„z`s7^' W0-I -. MSTANDARD.DEDUCTIONALLOWANCE"
20_Pay 20_
Lesser of 112 Homestead
Valuation or 535.000 $
Signature of Auditor Date signed