HomeMy WebLinkAboutHomestead_HelsleyCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT /STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for tiling instructions.
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I (We) 6 1 O a 0 - - - certify that on WITt d�yvf 9101, 20_
1L..(�W-,e) occupied as our principal place o r sidence the following described real property for which a Homestead Pr erty Tax Credit is hereby claimed'-
(We) owned ❑ Are buying under contract
lk Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the p p 2sc`1Sltft yMg underlaWnZract.
. y-m.- '3 snwi "i •. t�4 x,.�' i `°xCONTRACTRECORDED' ` .+W"� -.r. :'
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
a ' y:.. `2si "a F jr•'s �' '.t.9P,ROPERTTY. DESCRIPTION
County
Township
Testing district (pry, town, township)
Parcel number
I Legal description
Is the props in uestion:
—
Address (n rand sheet " ,stare, ZIP coder
Real property ❑ Mobile Home (I.C. 6-1.1 -7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediatety surrounds That stru re is used to produce income, describe the use and portion
of the property utilized to produce income.
- 3 - 3- OD -oa0. o - •
��k�'S.��'.� -.. PROP .ERTY•OMINED��BI(�CLAIMANT;IN,' OTHER "COUNTIES�.�.,�;'�`�:y�.�?��w 'dam..;.; �sR= :�',__�,��"
County
Township
HOIAESTEADD"�
County Township
I hereby certify the above statements are We, correct and complete.
?.�txVALUE
Si ure I claimant
Address (n rand sheet " ,stare, ZIP coder
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•°"� `"` —a, "FS"`'¢'
±ASSESSDR�USE ONLY �� - -_
R E AX x
> r''
ASSESSED VALUE
HOIAESTEADD"�
1 N- RESIDENTUIL
a:— L SIS1 .,_ „. -r.,.• `yTM
?.�txVALUE
SAT�i100 %:OF�'TTV
�'. uVAL'UEC
.VALUE •a .rr^
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2),`
~
T” land (line 1 plus line 2)
(3)
Dwelling
(4)
a __:;sa
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Residential Improvements or Annuatly
`'
Assessed Mobile I Manufactured Home
Garage
(5)
E
'`f
Other improvements
(6)
>t;;f W
Trial improvements (line 4 through line 6)
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Total value (line 3 plus line n
(6)
hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
TANDARDDEDUCTI0N ALLOWANCEti °'X ry. ' ..•.� -. .,": �2k 't' %t''`'_,.s."..f+.`f#y°j:�. yr+
20 Pay 20_
Lesser of 112 Homestead
Valuation or $35.000
Signature ofNrditw
Date signed
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