HomeMy WebLinkAboutHomestead_Mathews4�R�� 4 CLAIM FOR HOMESTEAD PROPERTY TAX
''*-'�" CREDIT/STANDARD DEDUCTION
'���J Slate Form 5473 (RS I 10-0t)
Prescribed by Ihe Department of Laal Govemment Finance
INSTRUCTIONS: See reverse side lor tiling instructions.
FORM � YE R--I
HC10 v
Lµ ��+ye 'k . ^' � .a �r �.n- -�_-": •�- . - - �:' CERTIFICATION STAiEMENT'�: . . � . . '� �. �"'� °� '—
I(VJe) � ify lhat on the tst`d'dybf �afch!2tYL
I(We) ouupied as our principal place of residence the following described real property for which a Homestead Propert ac Credit is h reb � aimed:
❑ I(We) owned ❑ Are buying under contract
�lave a benefidal interesl in ihe entity Nat is liable for ihe property taxes on the property and that owns ihe prope or;�s9fr�8Ftj('u�d�+raLdnUBiT�
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�is:� r��s �*'�?= t�.a�`LSr'�,t'k=-3$-.�x ��r� 5.:=:CONT(2ACT'RECORDED�':.5.,� � s,s,_� i� :�� � -
If buying on contracl. Fee Simple owner's name
Recordefs otfice where contraC is recorCed Record number Page
County
Tavnship
sWclura w Ne IanO not exceeding one (7) aae Nat
ice income.
�i� �c
�
town,
property in queslion:
❑ Real pwperty ❑ Mobile Homo p.C. 61J-7�
thai sWUUre is usetl lo produce income. desai6e �he use and porlion
-- _-- - - — -..
i`�s-z�-a �5.�,,,.':'-:i"�ur�:� .-�-'?�PROPERTN-�OWNEU�BYCL'AIMANTIN�OTHEF2'COUNTIES ,' . �-_;?7.',�` i��'k.'-,t � �� ""'m - -':-'
Couniy Toxnship County To.vnShip
I hereby erti(y the above statements are W e, correct and wmplete. Si a:ure aima
'�+re (numb en streel, c� stafe, ZlPcode)
% � %t/ %
� �����ASSEh50R�S�E„�ON�iJ �` { � f�TRUETAX� �. ASSESSEDVALUE r�HOMESTEAD .. ���� NON VALUENr,.��$��ixF'
,�" r.a VALl1E= �AT100%OF-TN •VAI.UEYS �
Land not exceeding 1 (one) acre immediately �=+' �,� �w �+%i �,'$7�� �; -�s'`�r^
surtoundingresidenUalimprovemenis. (�� €>-•,�.JyP,��`�t°-,;-,K,��;:�;��,°-�
:i�:-'�i_-'�.�y+•t3i%i: `; �;sE _ '
Otherland (Z) ;;=e•�,�:-a.T.c�t' -,.,+,�
.:rr_.: �' ^ , 3
TS.v
Tdal land (line 7 plus line 2) (3)
� -� : � �Yc '=
Dwelling �a� � �,� t �„r�r � �` -�:a-.��. �i,;
Residenlial improvemenLs �"'" � �� "�' �' � �' x� �
: �''"� �?'���`��':���,���-
Garage t '-�
(51 . ts,.°`„3:;,�:.`�"..'R:�`'c`":t %
. _F. »{s ' .y.r _ —
Other improvements (6) � '-,°. 3 ��„
' o,j: �,..?+,.,; 'T
Tctal improvemenLS (line 4 through line 6) (7)
Tdal value (line 3 plis line n (8)
I hereby ceRify the above is W e, correG, and Signature of Asseswr Date signed
mmplele.
Verifying actbn - Signature oflwdiWr Date signed