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CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
` ' State Fwm 5673 (R8/7-07)
Prescnbed by Ne Deparlmerrt o( Laral Govemment Finence
INSTRUCTIONS: See re�srse side /or filing insWctions.
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MAY 2 6 2009
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I(We)� ��/I�-t) /ii qL Qr] �, 7/ Y�Lt.I/L�t. certtythatRogn�thNe7rs�� �
I(We) occupied as our prinapal place of residence the following described reai property for which a Homestead Pr�iLrty'! �mcL it is ereby daimed
�1 (We) owned ❑ Are buying under mntract
Have a benefidal interest in the entity that is IiaWe for the property taxes on fhe property and that ams fhe property or is buying under a contrad.
If Wy'vig om m�traa, Fee Simple ownefs rrome
Recadafe a16ce where conlract is recorded
Caunry
Pa�cel number
Toxnship
If eny porlion of the resideMial shucture w the
dihe praperty WGZed 10 pmduce incvne.
Is Ihe prq
a� - a i/
one (7j acre ihat immetliatey wrtounds lhat
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o7C ir -�- ��- ao% � ��- aa �
Record number � Page
al property ❑ Mabile Fbma (IC b7.7-n
is used to P�duce huome. deuribe Ne use and portbn
,. , . . .. . .
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LarW not ex�rg 1 (one) ave irtvnediatey ;j �' �•:.. . .., . . �:�
surroundirgresidentialimprovemenfs. ��� '?_`r�`,.,c,<>4':;=:.+is��::>;�:-�;��' ---
Otherland ; "1s,.
�Z) .,F
TUaI WtM (line 1 plus /'u�e � �3)
3 �� � a ��tz,k - -.
#if p P�I
ResidentialimprovementsorMnually Dwelling (4) :���t„iy.���:���.f,�`,``>`,-„?x,�:t.r�.�?
Pssessed Mobile / ManuFach�red Home i?�,�*` laY,�w�.`�-�,a�'k{ �: ,� �
Garage �5� �K � �",-:,�'r`,�-'�S'"'�,�..-� � -:
._.:ze .''t �:�v;: .. ., -
• *<..� _:: s: ���:,:-
Other improvements (6) '"?'�?"'='s�.=`:(':' ' �'---
_ .�,v,._
Tcial improvements (line 4 through Gne 6) �7�
Tdal value (line 3 pl's Grre � �g�
I he2by certiry Me above is true. carect. and signaWre ot0.ssessa Date signed (month. day. rea�
complete. �
Vaiying actim-SignatureofAUditor Date signed (mmN, day, yea�
2b _ pay 20 _
Lesser of 12
Homestead ValvaGon
a
SignaW re of Auditd
45.000 for 2007 pay 2008 42.000 for 2010 pay 2017
44.000 for 2008 pay 2009 41.000 for 2017 pay 2012 $
43,000 for 2009 pay 2010 40,000 payable after 2012