HomeMy WebLinkAboutHomestead_VeachR;- CLAIM FOR HOMESTEAD PROPERTY TAX
-CREDIT/STANDARD DEDUCTION
/ Slate Fwm 5473 (R6 / 1-03)
� � Presaibed by the Depanment W Local Govemmem Finance -
INSTRUCTIONS: See revcrse sidc Ior liling fnsirticlions.
� ��ORM YEAR
C10
� �
NOV 051003
�- �. v . w - --�.-`�1
� M'e) c�russ�ma�clmJ�e.�s� dergrtirat�,, zo_
I(We) occupied as o r rincipal place of residence Ihe following described real property for which a Homestead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Ne buyirg under contract
,. Have a benefidal interesl in ihe entity that is liabte for the property taxes on the property and that owns Ihe property or is buying under a conVaU.
If buying om m�trad, Fee SimDlo owneYS name
RemNers ofice where mnVaIX is recorCed
'-""�itr r}Y_�i�'.'.��';:a�:.^tt��i'�5'a `»,�.fi�`�s:*�1?'..
County /j Tamship
town,
Record number � Page
Parcel numDe/r'y�� 9 Legal description Is the property in question:
O��- �/O � O'UU �Real property ❑ Mobile Homo (I.C. 67.7-7)
If any portion ot Ne rasidenilal sWdure or Ne land not enceeding one (1) acre that immediatey wrrounds that swUUre is used to produce income, desuibe Ne use and portbn
of the ProP�Y utd¢ed to produce i�ome.
County
Twvnship
1 hereby certify the above statements are We, wrrect and compiete.
(num6eraM�S(reet, city, sfate, ZlPcrode)
County
0
�, -•.• ••`r,.z ', �"r:� " +. ,. s.STANDARD:OEDUCTION'ACLOWANCE:vw�`�'���' "`' "T�?�3'��Z���.w.-�i�ke,:.�,.-'-
"". _�-�".°._a�v�*� y,-�5c?�m�U7�i _ . _ . .. ... _ ,,.rau`�..v`YY',!'�de�a''x�",',:ti �.r siva.._ .
20_Pay20_
Lesser of 1/2 Homestead
vauanon or E35.000
$
Signature of FudAw " Date signetl