Homestead_Miller (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` � State Form 5673 (RB / 7-07)
Preacnbed by Ihe Departmerri of Laal Govemmenl Finarroe
INSTRUCTIONS: Ses reverse side /oi filing ins6uch'ons.
FORM YEAR
HC10. -o
:t JL .lLJ JLJ
�(V'/e) .�VIL— i�'�'�� " certify mat on the i st day:a(�Marc�i?2¢ ��.
1(We) pied as our prindpal place of residence tlie folbwing described real property fa which a Homestead Property Tac Credit is he�rep�, datd�ed:
] I(We)owned ❑ Arebuyingundercontrad �%�`�>`����OUP!?YAUDITOR
, Have a henefidal interest in the enfity that is I'�able fw the property taxes on the property and that owns the property or is buying under a contract.
It btry'v�g on cmUacl, Fee Simple mme/a ,mme
contract is recorded
Counry
Twmship
townshiP)
Record number � Page
PaicN number legal descnpGon � Is Ne pr ui ques6on:
N rv 3-3 -/� �• A L ❑ Real prope ❑ Mobile Fbme (IC 6f.7-n
If any portion of Ure resitlential sWCWra or Iha Wnd not eaceedirg orre (1) acre that imrtrediately wrtounds Ihet sinx,Yure is used W produce'cuvme, describe the use and portion
d Ihe popertY u�i�zed in producs inmme.
a� -1�-0�.�00-00�. � o.�-���
oo��ry
Toxnship
I hereby certify the above siatements are We, correct and completa.
(number arM .sbee4 �y. sfate, en0 LP code)
Counly
�. � � � .� � �
i�'. •
Land not exceedirg 1(one) acre immediatety -: � , -_, ..
surtounding residential improvements. I�) .'� �i�: �1� � �
Other Wnd (p� 5 .' ..
Tdal IarM (line 1 pluslrne 2) (3�
Residential improvements or Mnuaily ����� �4) '
Assessed Mobile / Manufachued Hane - : .. � .. .. . . .
Garage �5) - ' - . .. - . .
_�.;� ,:?:--�
Ott»er improvements (6) �`= '-"'` � `"
tt .;i , - ;Ci.; � �
Tdal improvements (line 4 through Gne 6) �7�
TUaI value (line 3 phs Grre n �g)
I hereby Geftify the ebove is We, corieCt, and SignaWre of Assessw Date signed (month, tlay, year)
complete.
veiryin9 aam - sbrmwre a a,duw Date s"gned (manfh, daY• Y��)
. pay 20 _
Lesser of 12
Homestead Valuation
w
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44.000 far 2008 Pay 2009 41.000 for 2011 pey 2012 $
43,000 for 2009 pay 2010 40,000 payable afler 2012
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