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CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDIT/STANDARD DEDUCTION HC10
State Form5473 (RS / 10-01)
Prescribed by the Department OF Local Government Finance
INSTRUCTIONS: See reverse side forfiling instructions.
CERTIFICATION STATEMENTr;?,'
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I (We) 1.4 M ifytqt s' da y of March, 20
1 (We) occupied as our principal place of residence the following described real property for which a Homestead Propelyt 'Crediti, hereby claimed:
❑ l(We)owned ❑ Are buying under contract
_Wave a beneloalmlereslin the entity that is liable for the property taxes on the property at
/ftGh';atbWnt-1 �Of(� Y AUDITOR a contract.
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SON COON oFi I
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NTRACT2RECORIDED
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
Nel
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County
I Toomship
County Township
Taring district (city, to", township)
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I L des di irj)*ft�
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Is the property in question:
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Land not exceeding I (one) acre immediately
_
❑ Real property ❑ Mobile Homo (I.C. 61.1 -n
If any portion of the residential structure or the land not exceeding one (1) aab'KatirA:—�-ei-Auffounds
that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
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County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Si atur eofc
umber and street, city, state, ZIP e
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WI;ctjv9-MWA?�v. rri STAN DARDI D E D U CTI 0 WALLOWANCE
T RUE TAX �W
ASSESSED
XoH 9MESTEADi-
MO0ET1&ik TZ'A'; LSSESSOVSNLW
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Land not exceeding I (one) acre immediately
Date !Fed(
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
ON`
Residential improvements
Garage
(5)
Other improvements
(6)
Tdal improvements (line 4 through line 6)
(7)
Total value (line 3 phus line 7)
(8)
I hereby certify the above is true, totted, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
WI;ctjv9-MWA?�v. rri STAN DARDI D E D U CTI 0 WALLOWANCE
20_Pay2O_
Lesser of 1/2 Homestead
. Valuation or $6.000
Signature of Auditor
Date !Fed(