Homestead_Boyd (2) • --. - .
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CLAIM:FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION - HC10
:- State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
gA.31.'„?..?•••;Vcz;=`,::";;;_tAt.4._rc.2M7.4.3,41-i'l=.AR.:;:...:-;-1.-Sia4.;•r4c,CERTIFICAllON STMEMENT1-; .. - ,...,_ :: ..'..-: ,,, - ..m:.; -.
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l(We) 11\ AO I 1121 150 a. certify that on the 1st day of March,20
I(We)occupied as our principal place of residence the fi Ito .ng described real property for which a Homestead Property Tax Credit Is hereby claimed:
Ea I(We)owned 0 Are buying under contract
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it Have 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.
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
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t.41:Wkatir.4*ii.'%4.);--j4/2-417-4P-Ar.;.ifrig..:%C.irii.4.E=t_jj'T;i'f;PROP-ERrilDESCRI-_ - 10:•'-= -.-- .. 17,;-:' tz-,;.''.:'.:-•
County Township Taring d thc (city,town,township)
the-Y.40j n-.0(1-Q
Parcel number- _ - L al description Is the property In question:
0 17:oolo.5 -66 (-Pt-,5P J_ 34-2. al property 0 Mobile Home(I.C.61.1-7)
If any portion of the residential structure or the land not exceeding one(1)we that immediately surrounds thaFft,ure is used to produce Income.describe the use and portion
of the property utilized to produce income.
02‘-*/70A j#,-(1140./6 it 0 a A
tSVZ:V.--tM-12,4--T.re-gctsk;(7.;St*ri.n4itirl.',80,ikopERti:ofArivEriletcithimAktik'tiTHERrciouNtiEs :-v-ii.lci-,.`i'tz ...r."-. -4-atz'alf....It.-"..-74-,-i,32f--..:V.3-.--,7::ct
County Township
of claimant
I hereby certify the above statements are true,correct and complete. Signature
il
'tress(number and street,city,state,ZIP code) County Township
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4-FlefKW-R o'''ett;-=tiZtlit,gelv.z .: likfr.-1.:-Fil..5„4
',3fi- tite1--#47.7.1t,rhadrig..:;17,7--,:isit.;:ictA54;t; fiE.i :-.1-%;-a;ATi-4g9s0sE6,vF4Atu E momEgitapy ' ? iiiiilkiii ,-?j-,
%2TTvc .:
..,;:k.-,:vA.I...yEs!.:::.x..)27,..t.,-...tg,:p../.*uEj,:r,t„.,,,,:.,: ,
Land not exceeding 1 (one)acre immediately ,‘•-•r-T%-t .r1;V:s:14.-Qp,-,...-.:;-,-:
surrounding residential improvements. (1) ....- -.7'..rit ha,::'-tia?••••;•:4-.;;•-•
Other land (2) .:'t, ' - 1,4-,,E.
Tctal land(line 1 plus line 2) (3)
.1 'Cc,
Dwelling (4) .: :-'4' :ert,d-4:'''fiT117.".r:;- -t5ct
Residential improvements or Annually
Assessed Mobile/Manufactured Home
Garage (5) ;, ::7,74::::,:t4-r:z4:-..
ck-;-...."..... .".•;?...:74::..7.—:,. -,%C..:,?.:---ke.,:.:
z.t:,
911e r improvements (6) 4--k-.".;•;:"4:*:4-...9-1::•
Taal Improvements(line 4 through line 6)
Total value (line 3 pits 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
20 Pay 20
Lesser of 1/2 Homestead
$
Valuation or$35,000
Signature of Auditor Vefit,_ LLNS_\stit, tri' _ - _
Date signed
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