HomeMy WebLinkAboutHomestead_Eichmiller' CLAIM�FOR HOMESTEAD RROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t Stata Fortn 5473 (R6 / 4-03)
' Prexribad by the Departrnent a( Local Govemment Finance
INSTRUCTIONS: See /everse side 7or Fling instn�ctions.
FORM
HC10
YEAR
. ..... ._..._, . __ ..._. __ .... . .. .... .... _..-. _ _ .. .�. . ..
��e) �' certify ihat on ihe tst day af March, 20_
I(VJe) occupied as our principal place of residence Ne following described real property for which a Homestead Property Tac Credit is hereby daimed:
7 I(We) owned ❑ Me buying u�Wer contreci
' Have a beneficial interest in ihe enlity Nat is lieble for Ne property taxes on the property and that owns Ihe property or is buying under e conVact.
I1 bu�Mg on conUxq, Fee Simple owners name
Recordets ofice where conVacl Is recorded
Counry
Tormship
I( arry portion of Me tesidential structura w tlre IanO
of Me property utlltred W produce income.
-Gi�.� -
aae
m
number IPage
Is ihe p`opeM1y in puastion:
�y2eal property ❑ Mobtle Home (I.C. �7.7-7)
surtounds Ihet sWGUre is used to produce income, tlescribe Ne use and portion
z _
-a'ac.:�, .. .r.��.� .,..�:n�.:si��: � i�§,•�?= P.ROPERTY,�OWNED�,BYiCI:AIIHANT:IN�;'OTNERCOUNTIES�v , ,..-..��+:ti-.. ,�<,S�'� �i„ :,�+� t���.`=
County TwvnshiD County Toanahip
I hereby certify the above statements are We, cortect and complete. Signature oi Ueiment
�1ress (number end sUeet, city, stata, ZIP coda)
�`�� ��"�°L" '�$'���"s ��� � � � i TRUE TAX�'`"" ASSESSED VALUE ,j HOMESTEAD ,. ° �+^ NON=RESIDENTIAL� .'
�.:..,��� ASSESSOR U�E ONLY��,.�''�'�"� ��VALUE� `f� AT�100°/.OF TTN '� VALUE '�`i . r?�-+-_`'"?� �, s,s x,..•.
�rtr..... _ . � i� . � �' VALUE�, r-�. "�:
Lend not exceeding 1(one) ecre immediateh/ -:�-.� r�,� � L �i1$ r��Kt';
-e;
surrounding res(dential improvements. (�) .: c �Tt,.,:;��.,. �, t.., �„,., : _
Other land �`��'`: ` `�` �';.: �s'; �.,
i�) v'�'•*'-'--
Tatal land (11ne 1 plus line 2) (3�
Rasidentlal improvements or Mnually �elling (4) : � � � ���� � Y. �. .'�.� 2x ���
Pssassed Moblle I Manufaclured Hana ��� �"'�;� . � � { �. � �
Gara9e (5) �' ''c<. _
'�'.�` <3.� :.i},- F. y. t � -
/_'.
G j �' 3 .
_Ojber improvemenLS (6) . � i `
...<.�, .
Rfal improvements (line 4 through lirre 6) ���
Taal value (line 3 phs line � �g� �
I hereby certify Ne above is We, correct, and � slgnawre of Auessor Dau signed
complete. .
Verilying allon - Signawre oflwditor Date signed
20 _ Pay 20 _
Lesser of 12 Homestead
Yaluation w 535.000
E
Signeture of PLditw � I Date si9ned
�C?
4
!