HomeMy WebLinkAboutHomestead_WilkasCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
SIaU Fam 5173 (R6 / 4-03)
Preavmed by Ne Depmtrnmrt d Lxal Gwemmerrt Finante
MSTRUCTIONS: See iercmo alds IbR6p iy07�ctiona
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FORM
HC10
YEAR
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��e) certiy that on ��1�st �aY Pt �, 20_
I(We) occupied as r principal place of residence the foilowing described real property for which a Homestead Property T�c Credit is hereby daimed:
❑ I(VJe) owned ❑ Ne buying under conlract �7.yjG �/1
a � N�
� Have a benefidal interest in the entity tha� is liable for fhe property taxes on the property and ihat owns the property or is buying under acon�act.
n1C_ ^ LIIUIIVf�
If htry'ug om m�vad, Fae Simple owners name
where conUad is recorded
County
Tamship
tlistrict (ciry, tawn, fownship)
Record number � Page
� (b�a�s c� � Leg scnpNbn JriT`.' /O-�,� I is the 7�PeO°Real DoWahY ❑ Mobiie Hano (/.C. 6f.1-7)
(..
f any porlion o/ Ne resitlantial sW cWra w Ne land nd exceeding ane (1 j aae tAat immediatey wrrounds that sW cture is usetl to produce inmme, tlesaiba Ne use and portbn
d 1he property uGf¢ed tn produce inwma.
S�a.c�.�� �.as4 ►9c.
�'G �a-io-�oa-��aPS=aa%
County
Twvnship
1 hereby certi(y the above statements are We, wrred and complele.
Address (numberaM sbeet dry, sfate, ZlPcade)
'�'���'g�"3"��"�`'��'� �r� �S s F��,- ASSESSED VALUE ' HOMESTEAD�"� ` ti' �NON=RESIDENTIAL �
'��-'..j . -+ ASSESSOR�USE ONLY� �,� �TRUESAX ,�
� t� VALUE""-���'eAT�100%'OFT7Ya ' �VALUE ?� � VALUE ^�� ��c
��rk�.�. ' ���.�x_elaPr�.:.�� .0 tr.i�C'.� �',-,au.-, _te ,. _ .:.,..1. �>-.� >.s ..,�+-s'<,... ....�rt� 2�� .�`.��'��... ....��.�"s'��
Land not exceeding 1(one) acre immediately � ��� t�:��.�`',�-��,- �§4s,.��"
sunounding residential improvemenGS. ( � � �}3� �''��L�,,�$s�
Other land �'�''� ` ` �Yf". x .
J�-y
�'2) i.s� . .�� i�`��
" �:.�'� � eS
Total land (line 1 plus line 2) �3�
t ���� ���y�����
Dwelling (4) !'����,. �. r .�
�Residential fmprovements wMnuaOy
Assesaed Madla / ManutacWied Flome Garege 5 r.� `''�� �>'��'�i
( ) �a< ���a�d�s�u
�SG. ."���ti W�v
Other improvements (6) �-�` -
�._������
TUaI improvemenfs (line 4 fhrough line 6) ��)
TUaI value (line 3 pl's line n (g�
I he�eby certify the above is We, corted, and Signatura of Assessor Date signeA
complete. .
Veriying acGon - Signature of PLtliinr Date signed
20 _ Pay 20 _
Lesserof 1/2 Homestead
VHUeLOn orf35.000
S
of Aud'rta � n n �� � Date signed