HomeMy WebLinkAboutHomestead_Memmer (4)t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
t State Form 6473 (RS 110 -01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
FORM YEAR
65, HC10
I (We) � certify that the M , 20
I (We) occupied as our principal place of residence the following described real property far which a Homestead Prop I (We) owned ❑ Are buying under contract , T'r aLtD170R
a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
NTRACT. !.RECORDED���az� ..- _- �r.��,•- ��?'"T,y`r��"t:�x ���•! '�'_`
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
:xn i z16 .ap :'J -sip: P,ROFERTY:DESCRIPTION?:,,> ! ,o f;- ?" 'z�^ra�.�fy`�CG" a !i°.,'' P'i
County
Township
Tadng district (city, town, township)
j/rgrtyber
Lea a bon
Is the property in question_
(V 1l
VALUE. 3'"�I
❑ Real property ❑ Mobile Horne (I.C. 51.1 -7)
If any portion of the residential structure or the land not exceeding one (1) ace that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
'06PROP, ERTV; OWNEDBYCLAIMANT
;IN;OTHER`COUNTIES
County Toxnship
County Township
I hereby certify the above statements are true, correct and complete.
Sig tur of claimant
iW1 (number and treat, city, State, ZlP Code) r
OFTTV
I I
ASSESSOR USE'ONLY --�y �
1 v�..-.".�'� ?ss1
@TRUE TAXI
ASSESSED VALUE
r +HOMESTEAD
-';
NON�RESIDENTIAI
-
�.�'ki.VALUE'tATt100Yo
OFTTV
VALUE. 3'"�I
Land not exceeding 1 (one) acre immediately
45kv1"w "F'^
surrounding residential Improvements.
Other land
(2)
f'- W
.N:,
Total land (line I plus line 2)
(3)
Dwelling
(4)4€
fi iA'L`�r.
Residential improvements
o'#
Garage
(5)
Other improvements
(6)?+'t'�s
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
hr �ti` i `o`'-.- ,1ir,.,�T•{a,.�«t_{"a.n. TANDARD:DEDUCTION ALLOWANCE a3s?,;eT- '�i.,ef;, Ss $'`'. ,,'"d`,t14F'+• ,'_+.„:ri3 =2
20 Pay 20_
Lesser of 112 Homestead
Valuation or $6,000 $
Signature of Auditor 4DIrl Date signed
5- I _