HomeMy WebLinkAboutHomestead_BryanCLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
State Form 5473 IRS 14-03)
Prescribed by the Department of Local Government Finarim
INSTRUCTIONS: See reverse side for riling instructions.
FORM
HC110
YEAR
I (We) L-n, I I - A I CLA 0 1 certify that on the 1 at day of March, 20_
1 (We) occupied as our principal piece otnasidence the 10 lowing described real property for which a Homestead Property Tex Credit is hereby claimed:
F-1 I (We) owned ❑ Are buying under contract
& ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
-'IkX.sC',ICONTRACTI RECORDED
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
;- -A PRCIPERTY: 6 ESC RI RTI ON
County
Township
Township
TwinZarict
(city, "ship)
0 M
Parcel number
I
'930
(number and street, city, state, ZIP code)
property Is the pperty in question:
Land not exceeding 1 (one) acre immediately
�
Q34eal property ❑ Mobile Home (I.C. 6-1.1-7)
If any portion of the residential structure or the land not exceeding one (1)
of the property utilized to produce income.
aons that immediately surrounds that structure is used to produce income, describe the use and portion
9
c?,I, /3-
79-3
STANDARD, DEDUCTION' ALLOWANCE-,.
PRO PERTX'OWNED; B*,-'C OUM AINT, IWOTH ER-,CO U NTI ES
County
Township
County
Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
(number and street, city, state, ZIP code)
STANDARD, DEDUCTION' ALLOWANCE-,.
20 _ Pay 20_
ASSESSED
k6 MESTEAD.,*,
'RESIDENTIAL:
NON.
3 uation or 535,000
S
0%
D* qgned
1 W1
_,,�ty-,;�QVAL91E N�
Land not exceeding 1 (one) acre immediately
RM4 Ego 4,
surrounding residential improvements.
XS*
Other land
(2)
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(5)
laer improvements
(6)
,O
Total improvements (line 4 through line 6)
(7)
Total value (line 3 pits line 7)
(8)
1 hereby certify the above is true, correct. and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Date signed
STANDARD, DEDUCTION' ALLOWANCE-,.
20 _ Pay 20_
Lesser of 112 Homestead
3 uation or 535,000
S
Signature of Auditor
D* qgned
1 W1
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