Homestead_Weber (6)CLAIM FOR HOMESTEAD PROPERTY TAX � FORM YEAR
CREDIT/STANDARD DEDUCTION „n HC10
` ' Slate Fam 5673 (RS / 7-07) qy `
Prescnbed by Ihe DepaNnerrt af Laal Govertmenl Finance 1
INSTRUCTIONS: See reosrse sde Iorfiling ins6uctions.
I M'e) �v Inl�.c! � W� � ce��rt�B2'Zst��March. 20_
I(We) occupied as our prindpal place of residence tlie folbwing described real property for which a Hpnestead Y�Tq�,�p�Jit is hereby daimed:
rrl I(VJe) owned ❑ Ne buying under contrad MA LUU7 .
Have a beneficial interest in the entity Mat is IiaWe fa Ne property tazes on ihe property and that owns the property orj5,4uying under a crontrad.
If buying on conUact, Fee Simpie ownefs rmme
office where contrad is recorUed
Counry
Twnshlp
Tadng dis�ric� (cdy, fown. township)
Recadnumher �Page
=�i�'=� 3Q�—G�l• �,��=`z�� � �s �a ��� � 4���:
❑ Real property ❑ Mobile Home (lC 6f.7-�
It arry porUon of the residerNal sUuclure a �he IatW not �ceeding one (t) ave �hat immedia�ely wrtountls that sUUCture is usetl In produce inwme, descriDa Ure use and portion
of Ne proparry uti6zed b p�oduce inmme. /�
P��r ��'a-�o
.- .
. . .. . .
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Land not ex�rg 1(oire) aue immediatey `'r y.. <' '"� �." .
1 �' � c
surtoundirgresidentialimprovements. ( � it >..,,���__.�:,-_,.�:�Fy-r -
�'iF� . � .`v
O�fiCf�2fld (Zi i �_''i .h�'��_h
':>z`...i:., � _.:.3i
Tctal IarM (I'me 1 plus Gne 2) �g�
Dw011i�9 (4) �+�&'x � y��ze=N7v�,fi�.� �+e�, �. � ;
Resdential imprwements orAnnually i°-xxN:st� c, ,.,.--<i���. � a?:
Assessed Mobile I Manufach�red Home °" ti'� �
Garage �5) ��c xti?��a"�'�.�" ' �.,'r rJ .
Ch't`bC`.�S �}rh�L"d f
1
�. '�J.{r �a.
Other improvements (6) -� �;;.�.. s•^.:; - <'
- ;>r:.r:.;2i.i'�:
s �i.::_r.-..:'.�S*:
Taal improvements (line 4 thiough Grre 6) �7�
Total value (line 3 pda Grre n (8)
I hereby certify the above is We, torteCt, erd SignaWra of Assessor pate signed (monfh, day, yee�
complete.
Vaitying aclim - Signatura of �mr Date signed (mmN, tlaY Y��
�.-� � � • •
pay 20 _ qs,ppp for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 qq.ppp for 2008 paY
Homestead ValuaGrn G�Y Z009 41,000 for 2011 2012 $
a 43,000 for 2009 pay 2070 40,000 payable after 2012 _ ,_ .
SignaWre of PLdita pate si9ned (monfA, tlaY.Y��