Form Hpc - 2005 Application For Homestead Preservation Credit - Missouri Department Of Revenue Page 2

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Fillable Form Hpc - 2005 Application For Homestead Preservation Credit - Missouri Department Of Revenue Printable pdf

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TO BE COMPLETED BY COUNTY ASSESSOR:

1. Owner of record of homestead property as of January 1, 2005:

2. Parcel Number:

3. Amount of Acreage classified as residential on the Assessor’s property card:

$

4. Amount of any new construction or improvements during 2004 calendar year:

2004

2005

5. Assessed valuation of the homestead (for allowable acreage) for the 2004

6. Assessed valuation of the homestead (for allowable acreage) for the 2005

tax year (see instructions):

tax year (see instructions):

$

$

7. 2004 tax year levy codes for the homestead:

8. 2005 tax year levy codes for the homestead:

Political Subdivisions

State Auditor Tax

Political Subdivisions

State Auditor Tax

or Districts

Levy Code 2004

or Districts

Levy Code 2005

3 5

3 5

–

–

–

–

County

County

1 1

1 1

–

–

–

–

Township Counties

Township Counties

3 0

3 0

–

–

–

–

Schools

Schools

0 9

0 9

–

–

–

–

City

City

0 1

0 1

–

–

–

–

Ambulance District

Ambulance District

0 2

0 2

–

–

–

–

Hospital District

Hospital District

0 3

0 3

–

–

–

–

Nursing Home District

Nursing Home District

0 6

0 6

–

–

–

–

Watershed

Watershed

1 0

1 0

–

–

–

–

Library District

Library District

1 2

1 2

–

–

–

–

Fire Protection District

Fire Protection District

2 5

2 5

–

–

–

–

Community College District

Community College District

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

–

ASSESSOR’S ENTRIES: I certify that the above information is true and accurate

ASSESSOR’S SIGNATURE

DATE

COUNTY

Completed application and attachments must be postmarked by September 30, 2005. Mail to Missouri Department of Revenue,

P.O. Box 478, Jefferson City, MO 65105-0478 or email: homestead@dor.mo.gov.

This publication is available upon request in alternative accessible format(s). TDD 1-800-735-2966

MO 860-3035 (12-2004)

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