HomeMy WebLinkAboutHomestead_Johnson (18)CLAIM FOR HOMESTEAD PROPERTY TAX FORM I J YEAR _
CREDIT /STANDARD DEDUCTION cta
State Form 5473 (RS 14-03) M
Prescribed by the Department of Local Government Finance Lj
INSTRUCTIONS: see reverse side for riling instructions.
E_RTIF.ICATION STATEMENT -. ii'+i;,: -+�'.. v'iLiyn,+�it•..'.. , - . 2
11�\ v,
I (We) I1 Arm-? . \k i _9.JZn, „ `a• 4N n r\� �„A certify that on h Ast day of'March, 20
ppI..�(We) occ ed as our principal p a f residence the follow described real property for which a Homestead PC; 'ttCJNaYCJuT
WUIi�.he[ebydai(ned:
I (We) owned ❑ Are buying under contract
Have 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.
5 '"'.' .• s -a 'z a a 7
�s.�'- rir'','evi•f.'..i. :CONTRACT. ?RECORDED ;•'>LirXa rn'•d tStvT?,� -Y �+r ^r-- C.s.''. 0%;?'S`'
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
RTY DESCRIPTION ' r -
County
Township
Taaing district (city, town, township)
Parcel number //
1 -
Legal description
Is the property in question:
I property ❑ Mobile Home (I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that swcture is used b preduce income, describe the use and portion
Of the property utilized to produce income.
C700 -Co/. /7o -COX/
k- z- F �"Fi Ar'• [T 3.r'. 3r' - ... _ _ _.._
.:�.t'...:t?ROP.ERT.Y,OWNEDBY CL'AIMAN7.INOTHER' COUNTIES? �}`.'>.� „,�`+„I';�.- ,Z"?n"r. *,,
County Township
County Township
1 hereby certify the above statements are true, correct and complete.
§ignaturq of claimant
'dress (number and street, city, state, ZIP code)
10417 GI Ra
VAL_UJ',_
- TXCi34r.`�`
;;,'ASSESSOR USE ONLY?`��
}-'d�ancC..F-'Ysh
.y ]{ 4
6 TRUE TAX :
T+
ASSESSED VALUE
.il
kHOMESTEA�
';
vYC'
NON= RESIDENTIALu
�a�r
'
VAL_UJ',_
AT 700% ,OF --, N2l
'.6tXAVALUE.a�.
Q'I"UE'��`.�
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
2
()
Trial land (line 1 plus line 2)
(3)
Dwelling
(4)�
Kati '`F F� >Y
s' 4
Residential improvements or Annually
,
Assessed Mobile /Manufactured Home
Garage
a
(5)
Other improvements
(6)
£ '.-
Taal 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
complele-
Verifying action - Signature of Auditor
Date signed
STANDARD' DEDUCTIONALLOWANCE91 -e*
20_Pay 20_
Lesser of 112 Homestead
valuation or 835.000
$
Signature of Auditor Date signed