Homestead_ElpersCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Fam 5473 (R6! 4-03)
Prescribed by Ne DepartmeM of Lxal Govemment Finance
INS7RUCTIONS: See �eve�se sidg /pifiling inshucGons.
�
FORM YEAR-,
i
Hcto �
I M�e) - �' . V°' '' ` ceivilv�{ha�f�Qh��€1�ay of March� 20
I(VJe) occupied as our principal place oi residence lhe following described eal property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under wntract .' �G ��`�
� Have a benefidal interesl in ihe enGty that is liable for ihe property taxes on the property and tliat owns lhe property or is.buy(qg,uqder a wntract.
If buyirg on conVaq, Fee Simple owners name
Recordefs affice where coniracl
County
ToNnslrip
district
Record number
Paryel ry'p�yEr ��^�(7 �Legal dascriDtion Is Ne propertj in ueslion: /
!'lV �—P 1 •-� x '' �
lJ �J v ! u ' I a oPertY ❑ n+opu
tl any portion o( Ne resiEential aW cWre w the land nd aueeding one (1) aae Nat immediatety sunounds Nat sWCture is used b produce inowne,
of the properry utilizeE b produce i�ome.
County
-/ /'UO'OSUU-
���!x,?�"����` �m€P
Tawnship
� ��/
I hereby certify the above sfatements are We, coned and complete.
s(number arM streef, ciry, stafe, ZIP code)
1o��3'w, 5a(� S Cl.�
tfe ot tlaimant
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L L 1` � i N .- `-�7 �l V�
Page
(I.C. 6f.7-�
e the use and ponion
��-T�'���� �`;�� ""`�"` �"�' �"--1� � �� y��' �3'TRUEeTA7(� � ASSESSEDVALUE �`HOMESTEADY � NON:RESIDENTIAL i
��'�^ niASSESSOR USE ONLY +?�'� s� rE.��s e� �= �,�k������ �
. � �ff,�, , •�?s,��, � _ ��.c �, ��VALUEy �� � AL�100� OF�TN� �VALUE� �� "-,�,.VALUE�-h?��` ��
Land �rot exceeding 1(one) acre immediatey -; °-`��?�y.6"-��"`- �y'*s-�"S�
surtounding residential improvements. (� � ?^�.����.-,c"d�yE.�u`-?
Other land -`;'+`����?�� ,-^'z'. �
(2) �{ � ,-kr
:: 'r__x3«.:i+ri `�
Tdal land (line 7 plus line 2) �3)
�-. W,f v--• �'.�
Dwelling (4) '�'��", a �` .J�.°T: {$, '�' .
z
�k T�"h' a.
�Residentiel improvements or Mnually �'�"a°A"�'`¢'��-"{"� '
Assesaed Mobile / ManuhaAUred Home Garage (5) f���H���s� � y� �
� �'�
.: a"v a_2,��,',�'�'a:'8i
Other improvements (g) t��'i,;,"' i"�
�-i>;4, ��:�
Tdal improvemenLS (lina 4 through line 6) (�)
Tctal value (line 3 plts line n (g)
I hereby ceAify the above is We, coved, and SiBnamre otAssessor Date signed
complele.
Verifying aaion - Sgnature ofPUtliror Dale signed
20_Pay20_
Lesserof 1/2 Homestead
vauauon w E35.000
5
-3d-06