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; ` CLAIM FOR HOMESTEAD P.ROPERTY TAX
CREDIT/STANDARD DEDUCTION
t Siate Fwm 5473 (R614-03)
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' Pro9aibed by ihe Departrnent ol Local Govemment Finance
� WSTRUCTIONSi See �eversaside Por filing instmctions.
� FORM YEAR
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� �e) � i � � ' `-'" "'" certity�BrBim�aJ.tl�eCd,9�'�faY of�March, 20 ..
I(We) occupied s our 'n ' I place of residence Ne following described real property for which a Horr��$��pQqy T�scY A�tlitITORreby daimed:
uUNi
I(VJe) own Me buying under contrect
`� Have a banefidal interest in the entity Nat is liable for Ne pmperty texes on the property and Nat owns ihe property or is buying under a conVac[.
If buying on conUSp, Fee Simple ownefs nema
Racordefs ofice where contreG
CouMy
Pafcel numbm Lepal description Is Ne
�,�n-���3�-� s���-a-�o .5G�
If any poNon ot the rasidenUal structure or the IarM not exceeding one (1) acre Ihat immediatey wrtounds
In
Rewrd number � Page
�I property ❑ Mobile Hwne (I.C. 6-7.7-7)
is usa0 to produce inwma, describa Ne use and portion
��- SSESSOR S ONLY��r }�,�'r'�Q j��TRUE�TAX�>''x ASSESSED VALUE HOMESTEAD xz `''`-,.� NON-RESIDENTIAL r�� '
_"�+_�;�sy.°w=�d.�44's.?3�?�KC+i''s-::�'ta�""..r-t.� r,?�iVALUE`-'�k.`�'� �ATS100%OF.�TTNs .c sVALUEe�-_" � ���F>i�VALUEr:: `„_�.`r �.:: ,;
bs��-.,�. . ._. ...._,: �..,,. _. _.�,�.��_.,-
Land not exceeding 1(one) acre�immediatery � ?:��� �,ti.��� +,.� <-;a�.� -�'
surtounding residential improvements. ( � � Y� ti_'���j ,�, 'm,� if� ,�`:
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Other land �p� E` r i.; ; t, :}:
.>•'. : , .
T�al IarW (line 1 plus Ifne 2) (3)
4 3'FM».i t t:}S�?' i ��a
Residenlial improvemenis orMnually �elling (4) -"� �t �� � �,-;tx ,�
Pssessed Mobile I ManufacNred Home Garege 5 ��` ". xa �'� �' �: �r��,s L�-
� I e5,,a, l;f:_2 t:> .=A `
g
O�qe1 improvements (6) , -
Taal improvements (line 4 through lirre 6) (7�
Tatal value (1lne 3 plts line � �g�
I hareby certi(y Ne above is We, cortect, and � Signam�a atPssessor � Data sipned
complete. .
Verifying aWon - SlgnaNre of Auditor Date siBned
lesser of 12 Homestead
Valuation w 535,000
S
Data signed