HomeMy WebLinkAboutHomestead_Overton (9)3 CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� Slate Form 5473 (R6 / 403)
Prescribed by Ne Department of Local Govemment Finance
INSTRUCTIONS: See revc�sc sidc lorliling insfrur,finns.
�
FORM
HC10
YEAR
I(We) _(1 // L� �� /V �✓� ���/ ' certiy that on the 1st day o( March, 20_
I(We) occupied as our principal place �esidence the following described real property for which a Homestead Property Tac Credit�is hereby daimed:
❑ I (We) owned ❑ Me buying under contract . ��� -�{ -� ^�� �
� Have a benefidal interest in the entlty that is liable for the property taxes on Ihe property and Ihat owns ihe'�property or� �buying unde; a contract.
If buyinq on conUaq, Fee Simple ownefs name
where conVaq is recarde0
�� sv�
m�/ / �y
H any ponion c
of Ihe property
Counry
b
Tavnship
Tacing disiriU
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Page
y�j Legal AeSCriplion Is Ne proper,y--i,n /question:
(1 '�0� � Real property ❑ Mabila Homo (I.C. 6f.7-n .
sWqure or Ihe land noI exceeding one (1) aae that immediatety surtounds that sWCture is used b Droduce income. desctiba Ne use and portion
ice income.
Tavnship
I hereby certify ihe above statements are W e, coved and complele.
(number aM s4eet„ciry, sfate, ZIPcoCe)
Couniy
ol
Twvnship
�� ' �"������"`��� sa��"�'`y�TRUE:TAX ASSESSEDVALUE g' HOMESTEAD� `Y �'S
x� �'�'A�SSESSOR�USEONL���� �' `VALUE� c,i �AT100°/aAFTTV � yVAIUEf' �NON VALUE��L
.��',FY.�'9;...�s',�z3S'�'��'�'.�''... � r'�R� ��. s, .,� ,a.4"�' ��,. _,.,�?.� ��Frid:�...s _.-���L��
Land not exceeding 1(one) acre immediately �.,�A��,�.`�" �.���?'���rv{
suvounding residentlal improvements. �» k�'-'�'��"'�x�"��'r,.��?
Other land . (2� �� �,��.� �
�:,m�.mtaaE'�. �r:�.�'S�
Tolal land (line 1 plus line 2) (g)
+�. FiF ' Yt,7S `TJ%�`. i
Dwelling (4) • '�' � � `��,5��
Residential improvements or Mnually ���`�-' ��' �`�
� 4 =G�h�' s.
Assessed Mohile I Manufactured Hortre Garage (5� ����a�'���r�
�'i.,.`4.�k ` .�' ,�,., sy-3`�
's`�� � =° �i
Other impwvements (6) � o_;,e��,t�s ��y
:� -il:ai`1��.fir.�.s
Tdal improvements (line 4 through line 6) ���
T�tal value (Gne 3 phs line n (g�
I hereby ceAify the above is We, torred, and SignaWre o(Assessar Date signeA
oomplete.
Verifying acl'an - SignaWre oflwtliinr ' Date sgned
_.�.� � _'_'