HomeMy WebLinkAboutHomestead_MessickCLAIM FOR HOMESTEAD PROPERTY rAx
CREDIT/STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finam�
FORM YEAR
HC10
�:_ - - :-1- _V. - - -
CERTIFICATION STATEMENT.! j "i A
I (We) CL /Y) Ct ce t on 17 ay of March, 20
r Vropert redit is hereby claimed:
I (We) occupied as our principal place of residence the following descri
!hQk real property for which a Hom'esteal
❑ 1 (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns t 414yei�*s ing under a contract.
lITOR
CONTRACT RECORDED
If buying on contract, Fee Simple owner's name
Recordees office where contract is recorded Record number Page
Kt?'+`t PROPERTY.bWNEDSY CLAIMANT wbTHERtOUNTIES
'-"-PROPERTY DESCRIPTIONV,� --c
County
Tavrfship
Tmnship
Taxing district (city, town, to—VI
Pa 6r61iLd92?9-LA-)
AT 100% OFTTV
�Tl City, state, ZIP code �
operty in question-
Vic
Land not exceeding I (one) acre immediately
F Real ?rope,.Iy ❑ Mobile Homo (LC. 6� 1. 1-7)
If any portion of the residential structure cu the land not
exceedilig one (1) acre that immediately surrounds that etone is used . produce income, describe the use and portion
of the property utilized to produce income.
2V -/ -/-- a',R
- np/
Kt?'+`t PROPERTY.bWNEDSY CLAIMANT wbTHERtOUNTIES
County
Township
County
Tmnship
I hereby certify the above statements are true, correct and complete.
)8tZimant I
AT 100% OFTTV
�Tl City, state, ZIP code �
It
k'UiE'6NLY
TRUE TAX
ASSESSED VALUE
HOMESTEAD
NON-RESIDENTIAL'
VALUE
AT 100% OFTTV
VALUE
Land not exceeding I (one) acre immediately
surrounding residential improvements.
(1)
Otherland
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile / Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through fine 6)
(7)
Total value (line 3 plus line 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
verifying action - Signature of Auditor
Date signed
�,
STANDARD DEDUCTION ALLOWANCE W
IMF 20 Pay 20 _
Lesser of 112 Homestead
valuation or $35.000 S
Signature tlitor I Date log
k A f I