HomeMy WebLinkAboutHomestead_Robinson (4)da v��
aE °, CLAIM FOR HOMESTEAD PROPERTY TAX
s���': CREDIT/STANDARD DEDUCTION
.�:,;�� - Sta;e Form 5473 (R2 / 5-92)
Tm�
INSTRUCTIONS: See reverse side lor7iling instiuctions.
occupied as our principal place of res�f]ence the
CERTIFICATION
FORM
HC10
YEAR
certify thai on t�g�t�a¢dqM� 9_
,. . �
real prop yior which a Homestead Property fx Credit is hereby Gaimed:
1�(We) owned ❑ Are buying under contract � , ��. ��.�� �
Have a beneticiai interest in the entity that is liabte tor the property taxes on the property and ihat owns the property or is t��r�� contraci.
- CONTRACT RECORDED �
It buying on contract, Fee Simple owner's name
Recorder's oftice where convact is recorded Record number Page
Counry
Parcel number
` � PROPERTY DESCRIPTION
Township Taning diStriCi (Ciry,
� - !�i"� K' —
legal description
�
li any portion ot Ne residential strucmre or the land not exceetling one (1) aae ihal immediatety surmunds thai strucmre is used to produce income, describe Ne use and portion
of the pmperty utilized m produce inmme.
= �,�. 9�,- ��-/
PROPER?Y OWNED BY CLAIMANT M OTHEH COUNTIES �
Caunty Township Caunty Township
;by certity the above siatements are true, correct and complete. Signa� of ciaimam
Add ss} �umberarNs7reef,aty,s7ate,ZlPOOde)
,11.�'� ( . S �
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
.VALUE VALUE VALUE VALUE
Land not exceeding t(one) acre immediately
surrounding residential improvemems. (�) � �
Otherland (p�
To[al land (line 7 plus line 2� (3)
Dwelling (4) _ ��
Residential improvements _ .
Garage (g) -
Other impmvements (6)
Total improvements (line 4 through line � (7)
Total value (line 3 pLs line � (g)
I hereby cehify Ihe above is true, corrett, and Siqnamre of Assessor Date signed
complete. '
;�irg action - Signature ol Auditor Date signed
L
ALLOWANCE
19 Pay 19 _
lesser ot 1/2 Homestead
Valuation or 52.000
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