HomeMy WebLinkAboutHomestead_Robinson� CLAIM FOR HOMESTEAD P.ROPERTY TAX
�� CREDIT/STANDARD DEDUCTION
t Siate Fotm 5473 (R6l d-03)
«
� •- Prescribed by the DepartmeM of Local Govemment Finance
INSTRUCTIONSi See raverse side for filing instmctions.
FORM
HC10
YEAR
•i.rt1 Yr'_,::.:.`..__.-,.;�c��F..,-_,._-, a�-..:�..�).e =_:'*.GtFi11h,IGA710 STATEMENTy[:. �.':` .. ." :; :.��.:-.. .r'
I(We) � certify that on tha tst day of March, 20_
I(We) occupied es our prindpal pl of residence the fdlowing described 2al property for which a Homestead Property T�c Credit is hereby daimed:
�I (We) owned ❑ !ve buying under contrect
Have a benefidal interest in the entiry that is liable for Ne property ta�ces on tha property and that owns the property or is buying under a conVacl.
If buyinp on conVSq, Fee Slmple ownah name
Recordere ofice where conVaa is recorded
numbet �Pege
Counry Township Tm6ng d' trkt (ciry, toim. fownship) ..
Paivel number Lepal �p��p(��� 1_ Is Ne property in pueslion:
O�� —G � IG —� �`-� -- � 1 � ❑ Real property ❑ Modle Hwne (I.C. 67.7-7)
II any portion of the �esidentlal sWCWre w the land not exceeCing one�lJ�ae Ihet immediatey surtounds Nat sWCture is used to produce inwme, descnbe the use and poNOn
W Me P�OeM uNlzed N P�uce income. 5� 3�.
� �,
:r'k''.x�.°'.�t.���:i:�O4��_+ .�,':,> �x-.1f �� r�iPROPERTY,�OWNED'BY,��CLAIMAlIT,IN�OTHER�COUNTIESA^�'a . �2�s �.�; .��+:". " ��+.._. �.
Caunty Tv,vnshlD County Twvnship
I hereby certify Ne above statemen4s are We, correct and complete. Signature o( de'unant
�ress (number end sLaet, ciry, atare. ZIP coda)
�. [�� AS ES OR U ONL� ^y � `�� � �TRUE�TAX'��� ASSESSED,VALUE szHOMESTEAO � �'� .��'NON RESIDENTIAL ��� .
= -;
�.se� s��:"r�:�=..t,.:��a-rsiu�'�`+.'`� �� .r':��VAI:UE; ���. AT_700%OFTTY' �r.�'VALUE .;�. }i�--'°,-+��.r:.VALUE ._� g .� .-
Land not exceeding 1 (one) acra immediately . ' , v � � - � � x `t�` " �' `��
' � �
surrounding residentlal improvements. �� � ...G., ; r.; ,
Otherland �y� _ , ' -"�C.,-�=
. .' z' .'' �. .. � -,.
Tctal land (Ilne 1 pfus line 2) �3� '
.. �.-�# 4 r�_ �;�+s
Residentiel improvemen[s orAnnualty �����9 (4� ;' `+ z "+ �*�� f '.,,' �`�" +%'
0.ssessed Mobile / ManufacNred Home ( , ry� �� ��-�y �, ��- �^' Y ' -:
Garege 5 x <
- ; �_ �.. _.,.
•,-t, -
Ojper improvemenLS (6) . �
,s
Trial improvements (line d thmugh lirre 6) (7� .
Tctal value (line 3 plts line n (8)
I hereby certify �he above is We, correct, and � Signawre ofnssessor Date signed
complete.
Verilyinp ection • SlgnaNre of Auditor Dete signed
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or $35,000
S
Dete si9ned
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