Homestead_HesslerdArt•n t CLAIM FOR HOMESTEAD PROPERTY TAX
''�-'�" = CREDIT/STANDARD DEDUCTION
� > State Fwm 5473 (RS / 10-01)
Prescribed by �he Department oF local Govemmem Finance
INSTRUCTIONS: See reverse side for (iling instruc�ions.
�� .-�_�. - - -- . =. . : . . ' 'i.' . � CERTIFICATION
1 M�e) / � !/ . / L/ c
I(We occupied as r principal place of residence the following described real property for which a Homes
I(VJe) owned ❑ Are buying under contract
,Have a benefidal interest in the enfity that is liable for the property taxes on Ne property and that owns
' s,:T�i1.� ;,w3-: T -":;[riC. -a*.c1-^'. ?'-_'... ,_. "'�rnuTOerr�ocrnoncn.a�.. '. ..-. �
If buying om m�traa, Fee Simple owner's name
Remrders otfice where wntract is recorded
FORM YEAR _ i
HC10
th�.orRft�lst day o^f March, 20_
ProCpe�}� T� C�e�i�Gereby Gaimed:
iro ert�v or i�buVM�l underl8to�liract.
Record number
Page
�'3'""�,iiE°� - ;E° � -R _x��"��. *' '�'°.�=;PROFERT.Y.DESCRIP.TION":=--;' '•e '• ' ;'"a_'`.'-!'; �-� .
Counry Tavnsh' T�cing ais�rici (' own, fo hip)
b '
Parcel number // L I descnptIio'ln / C Is lhe O�operty in q ion:
� O�� j"' � � � w 3 a , 7�C, , {�'�ea� property ❑ Mobilo Homo (I.C. 61.1-7)
If any portion of ihe resitlential sWdure w the land not exceeding one (1 � aae that immediatey surrounds lhat sWUUre is usetl to produce inmme, tlesaihe the use antl ponion
ot �ha property utilized t0 produca inwme.
7—
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--��"`�- 'i��'s�xt�� .3r,� �. r�5°-n_BROPERTY,OWNED BYCLAIMANTiNOTHER'COUNTIES ' �,_ :+'� + � �`' * - '�' "•�'`�`
��� . t �
County Tavnship County Toxnship
I hereby ceAify the above statements are true, wrrect and complete. Signature . i nt
"adress (number and s6eef, ciry, sfate, ZIP cod ) '
e.✓ �7 6G
z
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�p? �� � '�YASSES50 �USE ON Y y r�m- } i.. � ? VALU E ` � - �AAT E00 /o OF TSV HO VALU �D� . � �s+F` NON VAI:UEN� � R �� :
.r t r i� c : �X. �.'.
Land not exceeding 1 (one) acre immediately ,�< �` �2� T � � �� � � � `_
� �e -�F+a r �.
surtoundingresidentialimprovements. � � '��s�.',.;.s��.:.?tp�?�-�;,y,� =���-
Ofherland �Z� _ :� a°�::;<<�'�.�'
•r
Tdal land (line 7 plus line 2) (3)
DW2111ng (4) � jyt, a��� p�L �YEiJ„� � �i:.
Residenlial improvements '` � � �"'r �i'Y' ��" '
,'�'ti,.Y� t� ..:-i:rFrs"
Garege �5) �•v., �a�,s- 3�'Sr�`i.z: y" � �:�.
isfi�s ,��: i:�'.
Otherimprovements (6) � ��-
1� �
TUaI improvemenfs Qine 4 through line 6) (7)
TUaI value (line 3 phs line n (g�
I hefeby cerGfy thB ebOVe i5 W e, CoReU, and SignaNre of Asseswr Date signed
complete.
Verifying aclion - Sig�ture oflwditor Date signed
20 _ Pay 20 _
Lesser of�1f2 Homestead
/�lualion or 56�0()
S
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