HomeMy WebLinkAboutHomestead_GreeneCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDITISTANDARD DEDUCTION HCto
State Forth 5473 (R614 -03)
Prescribed by the Department of Local rSovemment Finance
INSTRUCTIONS: See reverse side for riling instructions.
_ERTIFICATIONSTA ENT-'- B g I (We) ` - `'f' �K�� ty that on the 1st day of March, 20
I (We) occupied as our principal place of residence the following described real property for which a Homeslqp� Rrot-r4 NQj6dit is hereby claimed:
_❑ l(We)owned ❑ Are burying under contract
bHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns tltftmp_ertyd,Auving under a contract.
If buying on contract, Fee Simple owner's name
where contract is recorded
Record number I Page
w `...� �-'- .. "'r''aM.N,.as e 'sOP.ERTY.OWNED;BY CIAIMANT,IIJ OTNER'COUIJTIES� ':'. .--.a � ?•`y~ '.`,3€i` ?+�k�. 's
County
Township
Taxing ,Pct (city, town, township)
Parcel number
L al description 9 p Is the property in question:
3 1 %o
dress (number and street, city, slate, ZlP code)
5 7U f i en fU � f6IG
td SF 5 /'I( A � ❑ Real property ❑ Mobile Home (I.C. 6-1.1 -7)
If portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
Of operty utilized to produce income.
&- 05- 3S- Lioo - nor, oov'
w `...� �-'- .. "'r''aM.N,.as e 'sOP.ERTY.OWNED;BY CIAIMANT,IIJ OTNER'COUIJTIES� ':'. .--.a � ?•`y~ '.`,3€i` ?+�k�. 's
County Township
County Township
I hereby certify the above statements are true, correct and complete.9natur
o c
dress (number and street, city, slate, ZlP code)
5 7U f i en fU � f6IG
` '' i SSESSOR U11 SEGO/ L' j '
MJRUESAXV
ASSESSED VALUE
HOMESTEAD
NON- RESIDENTIAI«'tr
VALUES s; Fes-.
"AT 100% OF TTV
.
;VALUES
=.si VALUE
YE.1
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
ey °i�""''T'i�'`Z.�"
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
'Residential improvements or Annually'
Assessed Mobile I Manufactured Home
Garage
(5)
Rtw-
2`�
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
i€:__.`''r1i.4',�.``. STANDARD: DEDUCTIONALLOWANCE
i? .._.
20 _ Pay 20 _
Lesser of 112 Homestead
vaiva0on or 535.000
S
Signature or Auditor Dale signed