HomeMy WebLinkAboutHomestead_DouglasCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
x '� = CREDIT/STANDARD DEDUCTION HC10
t•M , Slate Form 5473 (RS I 10-O7)
Presaibed by Ue Departrnerrt ol Lacal Govemment Finance
INSTRUCTIONS: See reverse side lor (ling instructions. —;�
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� M�e) - RJ certify thal on t`I�e�tal day ofL�1�urLh 20_
I(We) ocwpied as our principal ce oi residence I escnbed real prop for which a Homestead Pr , rty T� Credit is hereby daimed:
❑ I(We) owned ❑!ve buying under con 2ct ��� ///�
� Have a benefidal interest in the entiry Nat is liable for ihe properry taxes on the property and that owns the� �.o� js� e(a'cbn6att.
F�IFJITOR J
u nuyiny on convaG. Fee simple owners nama
contraa
RecoM num6er �Page
County Tamship Tating tlisuict (rity, town. townshiP)
Parcei number L I 'ption Is Ne propeM �� quesGon:
— ❑ Real property ❑ MobOe Homo (I.C. 6/.1-7) .
any portion o/ Me resitlenllal atrucWra or the land na a i� ona (1 � aae Nat immediatey wrrounds Na1 swch�re Is used to produce (ncome, Aescribe the use and portbn
ot Ne properry util¢ed tn produce i�ome.
a�-�g-aa-,o� -ooa- 33�-oa��
Twvnship � County
I hereby certify ihe above statements are true, wrted and complete.
Address (number and sVeet, ciry; stafe, ZIP cade)
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Y 20 _ Pay 20 _
Lesser of t/2 Homestead
Valuation or $6,000 5
Signahue of Auditn /� , ` Date signed
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