Homestead_Williams (13)d� rt•n°t CLAIM FOR HOMESTEAD PROPERTY TAX
'}- �° � CREDIT/STANDARD DEDUCTION
'e •• J Stata Fortn 5473 (RS I 10-01)
Prescribed by tAe Departmen� of local Govemment Pinance
INS7RUCTIONS: See reverse side for filing instructions.
FORM M YEAR �
HC10 �
�
-: 'is�E �. F 3� ...- a . -��.'°_. � �. :�'•r = . - CERTIFICAiION STATE NT =�: ' � • �' '"�'�� �—/ BJ
I (VJe) — at on'1hA`tsi�da� �w9ich. 20_
I(We) occup d as our principal place of residence lhe following described real property for which a Homestea operty T� Credit' hereby daimed:
❑ I(VJe) owned ❑ Ne buying under contracl
�lave a benefiaal iNerest in the en6ty Nat is liable for the property taxes on the property and that owns the p�ipereq�iCiilfll�fig yq�8r�n act.
�s ��,Ta�._'''-.w3/�i?✓sFs�a''t �+3i�-`�.c-i_�?:��:.c. s.:E.�'�",1�'-CONTRACT'RECORDED� _ s ''i�';�t �.,,i.� ..t�.'v - . ..
If 6uy'u�g on contrad. Fee Simple ownets name
Remrdels office whera contrad is recwded Record number Page
Counry
Tavnship
If any poNion ol lhe residential sWCWre or Ne land nol
of Ue property ulilized to produce inwme.
Tacing dislric� (city, fown, township)
Ne property in queslion:
❑ Real om0�
�
❑ bbbilo Homo p.C. 67.
) aue Iliat immetliately sunounds Ihat swcture is used lo produte income, descnbe Ne use antl portion
-a5-���1 �oti ib ( �
;`��.='ix�'��`-t..�`�5?`:-.,^-u,Y,.?S;`;,. -`.�`�arPROPERTY.:OWNEU�BVCLAIMANTIN�OTFIER'COUIJTIES'::s..rr�=:i�+t 4;�.�'�„" r-.'t3 -
County Tonnship County Tavnship
I hereby cerlify lhe above statements are W e, correct and complete. namre o I- ant
"res5 (num er and stree( 'ty, stafe, ZIP code) G .
�
� �t.�4�: �'- . ..- � t -_° ; -s.. ... . .. . - �
�"t' `}�ASSESSORUSEONLY �?�°-`�,c � -� � TRUETAX ,i . �ASSESSEDVALUE HOMESTEAD." � � NON-RESIDENTIAI`�� ���:
,"��.":1.#.��`i,u':ir3if�=_..,L'b�st��'.`._.��.:a'- .:s�,.:at..VALUE= �, �AT.100/aOFTN�$ ,z'.V/LLUEY� r�-l-. -_:.tVALUE.,,z.��r'a��s`C'.i-�si
Land not exceeding 1(one) acre immediately �f+ �"�`i ^�.�-Fi :� �`-:?
surrounding residenlial improvements. (�� ' �" „n:����+`�,r ;_ ��,�; =
t'�_�tarc^�4 it �� ry'r
�:CY� � ��r.
Otherland (p) .� ^X:�'.: �r?_�,
Tatal land (line 7 plus line 2) (3)
d e'� tit'it ; �V7�r"y :
Dwelling (4) b'}`�..' ..+ �w�',�.LU�.a.� �'>"1` �3'3
Residential improvemenLS �- �,.
����'3' =.�"' r -�--�,,:
Garage (5) ,:`M..+' `1.hj& y �-�^`�s "' w>i'.
. _ :. r.. ...
a .a.+x-ss��"�c"' ��".'�"3
Other im rovements 6 =;� �''��" "` =`_
P I ) ' s;3��'�' Y''.
Tdal improvemenLS (line 4 through line 6) (��
Tdai value (line 3 plus line n (8)
I hereby ceRify Ihe above is We, correct, and Signawre of Assessor Date signed
complete.
Verifying aclbn - SignaWre oflwdimr Date signed
:�"-+.,�Fe�`.S�?-.:�i ���'.:�..:.etr"��"' -� ;..�. �=::�ST/WDARD.DEUUCTION'ALCOWANCEt t ,�:'„S.av�w",.�r� a -:;.:�°-rn �-?��:��� �:�`�:�
20_Pay20_
Lesser of 1/2 Homestead
Valuation or 56,000 5
SgnaNreolAuditor Datesi =^ —��
7
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