HomeMy WebLinkAboutHomestead_WeaverCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fortn 5073 (R6 / d-03)
PrawiCed by Ne Departrnent af Lonl Govemment Finance
INSTRUCTIONS: See �everse side /w filing inshuctions.
FORM �� YEAR
t
i(ti'�e> / l' / G(/U r' l�� L(/ �lY�li`P�('' � certify thal o�qe�js�t d�q9LMarch, 20_
I(We) occupied as our princiDal place oi residence Ihe following desuibed real property for which a Homesteac�p�sqgrty T�PG�redit is #�Jereby daimed:
�(VJe) owned ❑ Are buying under wntracl v�� COUNTY qUDITOR
iHave a benefidal interest in the entity that is liable (or the property taxes on �he property and that owns ihe property or is buying under a conVaG.
I( byvig on coniract. Fee Simple owners name
Recordefs ofita where tonirat� is recorded
Counry
Parcel number
rw,nsnip
�
Tating
Is Ihe prope�ly in question:
N any poM1ion ol the residential sWIXure w the Wnd nat exceeding one (1) a�xe that immediatety sunounds Ihat
oF the property uGiized to produce income.
Record number � Page
❑ Mobila Homo Q.G 67.1-7)
is usad to produce income, describe Ne use and portbn
" _ _ __. ._ _. _ _ ,_ . .
'�"�'s.st��av a" �**�'�����P,ROP.ERTY:OWNED���BI'�CL''AIMANT,IN�:OTt1ER�COUNT1E5u��'`i�.'`�'�Y�.��,-..�"'.�� �;?'���r^".:�
� �..� -
County Twvnship County TwvnShip
. _ _ . " " _ . . .___ ._� _ . .
1
I hereby certiy the above statemenls are We, correct and wmplete. '9 � '( claimant ,
!
Address (number and s4eef, city, slafe, ZIP code)
�����' �a'`�ASSES50 �SEONLY�' g,.���"�*�TRUETAX���F ASSESSED'�VALUE � HOMESTEAD; '` ONAESfDENTIAL� F
�"sta.'�-L�i x�,.Y,.:. �' -@t-;t>^?..+r• Y���`� ;�,T VALUE�7{�,.�� -�AT.100%.OF,iTTV� �VALUE�� `� -� 5%VALUE�`+.z'^�.t�
Land not exceeding 1(one) acre immedialety ����'3}��:1�-+�'�� �s_N��.}^' �??
suvoundingresidentialimprovemenis. (�) ��'��`.�' � %a
-� �.t �Y . �X,rc _ -
m u �:s� .p;.
Other land (Z) � `° �� "7x�?�
`� v:���
Tofal land (line 1 plus line 2) (3)
:� �-� �aa�- s€ �a- � r-.;
Dwelling (4) sr �:` ,t�+rSrs . .�:+�"�
�Residential improvements or Mnualry # `��"°"`�' �` � �`''�
r . -�.�.�
Assessed Modle / Manu(actured Home Gara9e (5) '� s.q �- •`.>'�`, -?5
�"`�+"a;4��.',a'� � ., „ . #�
'�r_�`�� +JF
Otherimprovemenfs (6) ��`��� ��
Tatal improvements (line 4 fhrough line 6) (7)
Tdal value (line 3 pl� line n (g)
I hereby certify Ihe above is We, corred, and Signamre otnssessor oate signea
complete.
Veri(ying acUon - SignaWre otAuAimr Date signed
-`p`2�.w..x. �� . _� . . .�.c.-4- .. _ . - .
—s��Fi(�i�`�-�,�w,.:`�`.t.�.?�i47b �'�<'u>. .�.._3-STANDARD_:DEDUCTION'ALLOWANCE-_"m,',,L'ki't°.�.��;5,"�'w4.r-..., --- _ s.�c�..�
- �r -i7.��+J.9f�tx5" . ..r.-qxo .����,£'4-�{`�+f�?�Y'd'v;�`=
20_Pay20_
Lesser of 1/2 Homestead
va�uauon or 535.000
S
Signamreo/Auditor � DatesigneA