HomeMy WebLinkAboutHomestead_JacksonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Slate Form 5473 (R6 / 4-03)
ReaaibeE hY Me DepaMimt of Wral Govanrtbnt Finaxe
INSTRUCTiONS: See reverao tl� b ISp i�s6urliam.
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FORM
OCj HC70
J
YEAR
I(VJe) Ul/ certify Ihat on ihe tst daGy of Marct�. 20
I(We) occupied as our principal place of resi ce �he (ollowing described real property for which a Homestead Property T� CreUlt is h�ieti� daimed:
❑ I(We) owned ❑ Are buying under contract
'1 Have a benefidal interest in the entity ihat is liable for the pmperry taxes on the property and ihat owns the property w�buyiiig under a conVaU.
If buyirg on conUaq, Fee Simple owners name
Recordels otfice where wnirad is remrded
'a>._�,�.�.Ein:'v�rastus'�.-'-'-== .�?t-=�
�i=�3?t'.: ���w,��+. r.YC:t
Couny � Tamship
�O�l'i�c�?��S'DO �
N any poAion of Ihe residential sW cWre w the
af the properry Wl'¢ed W produce income.
Record number � Page
7acing aistrict (ciry, town, townshiP)
��pti . � Is the pmperty in question:
� ❑ Real property ❑ Mobtla Hwno (I.C. 6f./-�
exceeding one (7 ) aae that immediatey wrrounds t�at swcNre is used b produce income, desuibe the use antl portian
I �G -�y i� �?a3-�o� a��-Qa� I
20 _ Pay 20 _
Lesser of 1!2 HomeStead
wuetwn a 535.000
5
SgnatureofAuditw ,� v, ^. V �Date