HomeMy WebLinkAboutHomestead_Lewis (12)e, ^�� i CLAIM FOR HOMESTEAD PROPERTY TAX
;���: CREDIT/STANDARD DEDUCTION
� State Form 5473 (R2 / 5-92) �
;i :
INSTRUCTIONS: See reverse side for liling instructions.
FORM
HC10
YEAR
�3
� � /� .iVL=
:) f ,� �� � , - . ce�ifyitFr�t_�p�n thehs��9f March, 7
I �JJe) occupied as our principal place of residence the following described �eal property for which a Homestead �'mperty Tax Credi is hereby daimed:
❑ I(We) owned ❑ Are buying under contract .� �„��,,.�
❑ Have a beneticiai interest in ihe eniity thai is liable for the property taxes on the property and ihat owns t e p�g�p�p� �4nder a contract.
- . _ � � . FiVV�� . . . .
CONTRACTRECORDED
It buyirg on wmraa, Fee Simple owner's name � . � � � • . ' � ' '
Recorder's oHice where crontract is recorded Recortl number Page
� � .. ' . � . ._ - . _ "
Counry
Parcel number
al�-�
If any portion c
of Ihe propeny
to
� PROPERTY DESCFIPTION
Township � � Taxing district (ciry, fown, township) ' . -
Legal description
_o� . i..�. 3-3-� � . S �
cwaure or Ne lantl not exceetling one (1) aa that immediatety sunounds ihat siruaure is used to produce income. descnbe Ne use antl portion
�e incrome.
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES
o Counry
!a!reby certify ihe above statements are true, correct and complete.
Address (num6erandslreel. clry, stafe. ZIPcoOe)
- ASSESSOR USE ONLV
Land not ezceeding 7(one) acre immediately
surrounding residential improvements.
Otherland
Total land (line 7 plus line 2�
Dwelling
Residential improvements
Garage
Oiher improvemenis
Total improvemenis (line 4 through line �
Total value (line 3 p�s line �
I hereby ceriify the above is true, correct, and
r^mplete.
iina action - Sianature of Auditor
19_Pay79_
Lesser of ll2 Homestead
Valuation or 52.000
TRUE TAX
VALUE
(�)
l2)
(3)
(4)
(5)
(6)
(�)
(8)
Signamre ot Assessor
STANDARD
S
ASSESSED I HOMESTEAD I NON-RESIDENTIAL
VALUE VALUE VALUE
�\` -Si9natbra ot Autliroi - ' ' — —=
' " G� �,�..Q � I�I�L�-e�--
�
signed
signed