HomeMy WebLinkAboutHomestead_Peach4 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
` J State Forth 5473 (R5110-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
M
FORM YEAR
HC10
I (We) certify that on the 1st day of March, 20
1 (We) occupied as our principal place of sidence following described real property for which a Homestead Property Tax Credit is hereby claimed:
t1r I (We) owned ❑ Are buying under contract
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.
IA, -*.W- .�.cL P' iW ,V�'���- .x,4; .xi' ',tinr�^'CONTRACT.' RECORDED. -- v'r-�a'
If buying on contract, Fee Simple owner's name
Recordefs office where contract is recorded Record number Page
.... n.. 3:?t �lq- -y'&� �PROPERTY,<' - -
t "W5 -'1t^ -� .. ',.0 n � DESCRIPTIONir
County
Township
Taring district (dry, town, township)
Parcel number
Legal description Is the prepe in question:
property ❑ Mobile Homo (I.C. 61. 1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stm&ure is used to produce income, describe the use and portion
of the property utilized to produce income.
4
County Township
s-- =x,.�,-«.. �:
TRUEzTAX >
County Township
hereby certify the above statements are We, correct and complete.
. NON'- PRESIDENTIAL �
Signature of claimant
Address umber arM street, city, fate, Z/ co )
o LO
� J
vim"
��"
f ° .:'Y^= `�7u�st'y''�is','-'y`"�s" W
u-y ASSESS( ONLY
s-- =x,.�,-«.. �:
TRUEzTAX >
-
ASSESSED VALUE
=HOMESTEAD+''
'-
. NON'- PRESIDENTIAL �
S
+V4 - V new ,..��..� -s
w„ VALUE%
_AT�100%.O TTV
- +,NACU 4w
e.'-3m a< . VALUEn ''�T
Land not exceeding 1 (one) acre immediately
r'
surrounding residential improvements.
Other land
�� " ` '
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
.a v, Z3.
4?s ,..,
Residential improvements
62 &XI 4
Garage
(5)
' !t
- - s
- serr
3'-
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line n
(6)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
W - ;,r �.,_,,���,,/I}}ii.�..•��"�- °'jy' `STANDARD:DEDUCTIONALLOWANCEt;"
��r$3�
_ 20 Pay 20_
Lesser of lt2 Homestead
Valuation or $6,000
S
Signature of Auditor
Date signed
5- -