HomeMy WebLinkAboutHomestead_HelmCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc10
State Form 5473 (R41 8-00)
o INSTRUCTIONS: See reverse side for filing Instructions.
I (We) ce at on t y o- arch, 20_
I (We) occupied as our principal place of residence the following described real property for which a meste d rty aw r ereby claimed:
WI (We) owned ❑ Are buying under contract IIll FF II� ''tt ,,nn(n1'I
ave a beneficial interest in the entity that is liable for the property taxes on the property and that owns tlfc+pYapi 610 4 93ying under a contract.
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded
Record number ( Page
- r U w 4
_ _+A SkO�J3E ONLYIrG�,sS��
t�$ R_ OPE_RTL�ESCRIPTION�,,��"�°'��,.
Township Tax in U (cif}; town, wnsh'
ASSESSEDdVALUE
��yA.TS100% OFTtTVTAIUE_..,+?
my
Parcel number Legal description �/)�
o
�, yr `O
d - CX
7 •
If any 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 the property utilized to produce income.
Land not exceeding 1 (one) acre immediately -
-13 - o - o -off- 4V?3 -06
�'; -
` 3"-
:_,,,,,,_-•• �,�,,, ,,�'���"� .PROPERL_(- �OWNEDIBY- KLTLAIMA_NT
IN O1HEERCOUNTIES`= ��'v.3`°� _ ;�•S
N =�;�„- 1;f'�.� s�a:��;�'u
County Township
County
Township
I hereby. certify the above statements are We, correct and complete.
Signatu f dai ant
L
-115t
RRML
®ress (number and street, city, state, ZIP code)
Po Q V-f- 19.7 �- - - , .� y7 c0 S/9
BUSY I
- r U w 4
_ _+A SkO�J3E ONLYIrG�,sS��
TRUEFTP.JC
VALUE.
ASSESSEDdVALUE
��yA.TS100% OFTtTVTAIUE_..,+?
,,.NOMESTEAD�
NOW E� IAL
' c VALUE
, a -
Land not exceeding 1 (one) acre immediately -
(1)
�'; -
` 3"-
surrounding residential improvements.
_
a
-115t
RRML
Other land
BUSY I
Total land (fine 1 plus line 2)
(3)
" `_.
Dwelling
(4)
- ^
l `.
Residential improvements
Garage
q-
(5)
Other improvements
(6)
c.f;
RIM
improvements (line 4 through line 6)
(7)
1 value (line 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
`- x zh''.t 'STANDARD DEDUCTION)ALL'OWANCE °`^'ter`•
�•�.;�rt s_�$., _a_',13°. .x'_.�..%:��_..._u_— _..___
20 _ Pay 20 _
Lesser of 12 Homestead
$
aluation or $6,000
Sig tun flwtlito Detest n — /