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,�4 :, : CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR �
� CREDIT/STANDARD DEDUCTION Hcio
'� � State Form 5473 (RS / 10-07)
�O� Prescribed by Ihe Departmen� of Local Govemmem Finance
See reverse side for liling instructions.
. . _ ' i : il . • .
�(We) ,�C�� 7 LL_ 7`� � 1��j��1C C. d_/7 L��V cErtM�thal ob tNc�V+l4day of March. 20_
I(VJe) occupied as our principal place of residence the following desuibed real property for which a estead Property Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under contract J
�Have a benefidal interesl in the entiry ihat is liable for the property taxes on the property and k t�}gg(i�p pZgpp ur j�tgpl(�u der a contrac[.
,o"r. rzr.:_s�%e.'�' Y/$;-�'.—; rw_ ,�''.- ``x.: .. ' t . �. +� ;:fi::s �-��; CONTRACT�RECORDED '�,t.- _.. '> yt :._ . .
If buying on conireG, fee Simple owners namei
Remrdefs afice where contrad is recordetl Rewrd number Page
'� i ,�3
TwvnshiP
portion ot iha resiAential sWCWre or Ne land not
property uWized b produce inwme.
Caunty
-' „`P
Tavnship
. -PROPERiY DESCRIP - N .- _:,�� '_ .z. ' - . �"� - ' ...
T in is ¢I rty, town, to • sM
��� �. , ..
/� Is ihe propert�y in/qy estion:
��� � l�llReal DroOerty ❑ Mabilo Homo (/.C. 61.1-7)
!�
one ( acre that immediately surtcounds Nat structure is used to produce income. desui6e Ne use antl ponion
� � J
I hereby certify lhe above statements are true, correct and complete.
(number and s6ee(, ciry, stare, ZIP code)
County
TavnShip
f � ��''�`�ASSESSOR USE ONLY �' � - � -TRUE-TAX � �ASSESSED VALUE HOMESTEAD: � �� � � NONYRESIDENTIAL� ^' .-�
�'3"+:iC'.;..r.�.��-c`+-�-�^� t �:!=r . .'�VALUE. � �AT�00%OF.�T7V � VALUE��,y .` -. VALUE .if_ ,�s�F=:,'
land not exceeding 1 (one) acre immediately ��� � � � -� ,`' � � - - ?��` :..:
surrounding residential improvemenis. ,, , � � •
-:.-�t.s.':�::`.`�L'. - --
Other land (Z) __��::,�X:
Tdal land (line 7 plus line 2) (3�
_ "� r �.
Dweiling (4) i `�" _ � � ��� � 'zc S..
Residenlial improvemenis '' €� � ��� s
l� Yt � .� -x r "
. �+F^ JLS�.i Y iiK`y� ��iv.y1�'fr
Garage (5� Nhs; k.:..�. �.. -�.,.o,,( �.:,'.
.s..+y;..r�.. _.-.-�'c-..
OUier improvements (6) �� -� 'a� r� � '
--f.-:..�.:,�. ��
Tdal improvements (line 4 through line 6) �7)
Tdal value (line 3 plus line n (g)
I hereby certify the above is We, correcl, and Signawre otassesmr Date sgned
complete.
Verifying actbn - SignaWre otPuaitor Date signed
��'�".,�.��.;_,` ��N...:,.. ,�i"�i. � ,i`::Y=i?,t�'z _'��r;STANDARD:DEDUCTION�ALLOWANCE _ '=t'z,. � ;y->�` Y '`.`-t's_`.,r�.*f+���= ���.�-..;
20_Pay20_
Lesser ot 1!2 Homestead
Valuation or 56,000 S
Sgnature ot Aud"aor Date signeA