HomeMy WebLinkAboutHomestead_Holt��+ESi„E�` CLAIM�FOR HOMESTEAD PROPERTY TAX
; CREDIT/STANDARD DEDUCTION :
��e State Fortn 5473 (R2 / 5-92) .
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INSTRUCTIONS: See reverse side loi (iling insWCtions.
FORM
HC10
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C FIC N STATEMENT N_Z; �-, �t� ti •�+ ¢{�
I(VJe) certify that onthe � st day ot M ch, 9�
I 1(We) pied as our principal piace of residence the foilowing described real property for which a Homestead Property Ta�cf •6,r�d'M%s�h�"ub�j�Claimed:
(We) owned ❑ Are buying under coniract
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❑ Have a beneficial interest in the entiry that is liable for the property taxes on the property and that owns the prope'�i9�Or is buying�nde�',a contr�'t.
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CONTRACTRECORDED /.� � ='�'r �-'`��'"' � ��� �
If buying on conVaci,.fee Simple ownefs name
Recorders ofF�ce where conuact is recorded Fecortl number Page
PROPERTV DESCRIPTION
Counry Township Tag`ing tlis�(ciry, Iown, mwnship)
1
Parcel number Legal tlescnption
DC� - I 5 S �- P� ��C -
If any portion of the residential structure or Ne land not exceedirg one (7 ) acre Nat immetliatey surtounds that sVUCture is used to produce income, descnbe ihe use aM portion of
Ne pmperry utilized ro protluce income.
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PROPERTY OWNED BY CLAIMANT IN OTHER COUNTRIES
Gounry TownShip . County i
Signatur of claimant
.iereby certify the above statements are true, correct antl complete.
Address (number and sfreef, dry, slate, ZIP code)
, �2 '%3L' PoSe Li/ c .�n� 47633
ASSESSOR USE ONLY TRUETAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1(one) acre immediately (� �
sunounding residential improvemenis. �
Otherland (2)
Total land (line 1 plus line 2) (3)
Dwelling (a)
Residential improvemenis
Garage (5)
Other improvements (6)
Total improvements (line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify Ihe above is true, correct, and Signature oi Assesor Da�e signetl
complete.
Verifying action - Signature ot Audimr Date signed
� STANDARD DEDUCTION ALLOWANCE
19_ Pay 19 _
Lesser of 7/2 Homestead $
� Valuation or $2,000
Signature of Auditor Date signetl