Mobile Home_MaikranzI'
.
i CLAIM FOR HOMESTEAD PROPERTY TAX FORM
`T CREDIT/STANDARD DEDUCTION - HC10
`., / State Form 5473(R5I 10-01) -q - "'d
4.1• Prescribed by the Department of Local Government Finance , I
INSTRUCTIONS:See reverse side for filing instructions.
1/4 lfiF'� . d. w r' ek+-sf ,. i Y t ,--7# _ scn I rmtATION STATEMENT_; -+�w ri. + 472.:!)..:-L -5= "hart_ •- .1
i
I a (^% r �(i ,e_, cerrwtify`that on the 1 s ay of Mi rch,20_
I(We)occupied as our principal place of residence the following described reap operty for which a Homestead Property Tax Credit is'herebj,d aimed:
❑ I(We)owned ❑ he buying under contract
Save 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.
z =-.s F,i. .-:.r r ;tt tt1SCONTRACT.RECORDED•?'.: 1frfrr 4x.* T`.`:''r. x .SKk; . iy'' '.---r -
If buying on contract.Fee Simple owners name
Recordees office where contract is recorded Record number Page
....-tff a��^...-Sira,M°.dCtr;tartaMtnP,ROPERT,Y,DESCRIPTION �'t.IMP.. .'"'`R'� ...�....m:2.1- .;u'`= -
)Lei Tavnship Taxing tli n w ,tow shr.
I I A
Paa Legal description Is the property in question:
` _„ ccc a3'c)L ❑ Real property ❑ Mobile Homo(I.C.6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
/ 988 ti
KIZ a"1- e l '`Y•> f”.4.5�e' PROP,ERTY,OWNEDBY CeAIMANTIN.OTHER'COUNTIES . : Rali..d.'. C' W: 01-ti '
County Township County Township
($igL�ature of claimant
I hereby certify the above statements are true,correct and complete. 7 'I ,U ✓ m !
dr m.erand street,c state ZIP code)tio 6Za klarw.2 9. a 4'7(66 9,13r
• -E"v 5`-' - T" mss r' >'a�• TRUETAX i A ASSESSED VALUE ,3.t HOMESTEAD S . NON-RESIDENTIA: &i
�s. '°'£'ASSESSOR USE ONLY- ,„*c ,p ` vALUE ,i.`,¢ ZAT 700%e OFT.Y ;j�VALl1Egf- n ,,,:is}a;`m vALUE'� a?Vii`
Fr ,rts . ,rL. sTa'1 .un. c' RF+:kaw. x .. 74 i,.z i'{ F`
Land not exceeding 1 (one)acre immediately (1) 1 t'otl+'~3+F ,•.x-r$-•. '.
surrounding residential improvements. ;;��45�� •• ` 'r''h
Other land (2) iE- `% "'f'--
Tctal land(line I plus line 2) (3)
Dwelling (4) ..i iiPt' ' h l•
Residential improvements r# •3 ' 3-1 `l'' r '%3
Other improvements (6) -.s ,, ,+n.3.1 : `
Total improvements(line 4 through line 6) (7)
Tctal value (line 3 plus line 7) (5)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete. • J,1�
Verifying action-Signature of Auditor \ cb) \(1, \�\ \/ 1 n Date signed
i,.. ,5-yl rr aat--. ,: rc-r..f5ST1AAN ARD:DEDUCTI\O\\NN'ALLOWANCEx h_i.stS;W a:aw^sai ' 3S"tyIWagf:t4._:
,�1•� � -� � �i,�'��,�;a;,. -fir;
a � �
20 Pay 20
I\ Lesser of 1/2 Homestead $
V aluabon or 56,000
Si lure of!write I Dateasigned
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