HomeMy WebLinkAboutHomestead_Wilhelm, '� CLAIM FORNOMESTEAD PROPERTYTAX
CREDITlSTANDARD DEDUCTION
\ Stste Foim 5473 (R614-03)
" Prescribed by the Department of Local Govemment Finance
� INSTRUCTIONSi See reverse side (or (ling insbuctions.
FORM
HC10
YEAR
�
I(We) '"� c�, � fSl (� �'),.J 1�/`J IS�X T{1�� J ceNty that on the 1 st day of March, 20_
I(We) occupied es our principal place of residence the fdlowing described real property for which e Homestead Property T�c Credit is hereby Gaimed:
�I(We) owned ❑ Fve buying under contreU
Have e benefidal interest in the entity that is liable for Ne property texes on Ne property and ihat owns the property or is buying under a conVacl.
If buying m mrNeq, Fee S4nple owners name
otfice where convaa is rec«dad
number
Tomship
desaiption
is Na
rown,
Rawrd number � PaAe
� � l�..J —� �� i1i�\ �C\� �15� �Lm1 I �ea� P�Perty ❑ Mobile Home (I.C. 67.1-�
otthe residantlal strucwra a the IarM not e�eeding one (1) acre tnet 4nm i ey surtounds Nat strucwre is used ro produce income, describe the use and pwtion
y utli�ed to prodtxe inmme.
P}-�D-7 J ac�s /ao�
�.,.. . -
?aii��Y`Y.'.'i�.+fi� :�?!�`'iQ��ry,.��s'bR�t`:fijP.ROP,ERT�Y:OWNED���BY_CLAIMANT;IN',OTHER�COUNTIES'�� �4":.��-.s.'�-., . v S�' L. ,.�.-?�>x-r` zs�i<
Counry Twvnship Caunty Toumahip
I hereby certify Ne above statements are We, cortect and complete. Signenre otdeimant
iess (number end sUeet, crry, state, IIP code)
�'��r�� SSESS R S ONL �F~ti~ �y�Sc�� �, ��U y�"'`" a AAT>E OX OF TN` �H�V/LL E�5 ��� NON VALUENT+�� � y.
�: s�:L`�?fn^^".r,r.4�YRYFn?rs�..�'�S!�s`.l 'S�;�i.. ....,.Y. i—a. �-..1 r g` F�.-��'L�i:_.. .2K+.3? F_
Land not exceeding 1(one) acre�immediatety ~� ���,��y� ,. �"�'s'"�s �r �`
surroundingresidentialimprovements. (�) `': y,,..�,,.;;�,..,,�_�.,,t-:� ,r �.
Otherland � �
(Z1 ' - -
T�ial land (line 1 plus One 2) (g)
Residentlal im mvemenLS or Mnual �^'elling (4) `�' �' f f y ;' '�-� ` - µ�
v N �-i c r s;r t t. t '�
Pssessed Mobile / ManufacWred Home i � • .:� � � -
Garege �5) �y ,� a ''�. „ .�, x''
�l� �r'4 �' ml Si .
�tl..;r.
O�pet impmvements (6) ;'_ti,,, T,_ - �
Taal Improvements (line 4 fhrough li�re 6) �7�
TUaI value (line 3 phs line � �g� �
1 hereby certify the above is true, carrecl, and � Signamre otnssessor Date signad
complele.
Vailying acUon - Slgnatura otAUditw Date signed
`�`.7'°,K`3`.z'`��'i"'?''i�`,_n-}'�4 ..sL�;'"�','�,R�,�x�.��'STANDAROj�EDUC.TION'ALLOWANCE�.. :::�� , -,`,� ..:... q.._<„ ._.:,
20_Pay20_ �
lesser of 7!2 Homestead
Valuation w 535,000 S
Sipnatureaflwdltor Dateygne� ��/,
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