HomeMy WebLinkAboutHomestead_Adams (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
State Fortn 5/73 fR7 / S0�
Reasnbed by tl�e Depenrt�ent of Local Gwemmeru Fe�an�s
' INSTRUCTIONS: See raverse side tor filing instruUions.
FORM �� Y�R
��i� ���Qi,D FO TA TION
� y p� �LV E+. nce i < r
� J
9•jj�t'• j Subjzct io 6na1 atteP
�UL 0 �_ dat� :� �-� �
i�we� u �- 1 1 1 -' tha�ihe 1 st day of March, 20
I NVe) ooctipied as our prindpal place of residence the folbwirg described real prope8�� ich a Homestead . ��. .. daimed:
�rr��""'' .
) owned ❑ Are buying u�da mntract
'ave a benefidal interest m the entily that is IiaWe for the property mxes on Ihe poperty and that owns C�e property or is Wying under a contract
M Wy'vip om m�lract. Fee Sirt�le ownefs reme
Rec9rtlera o16m
Camry
Pa�cel nmiber
description
a e
Is Uia property in QuesUOn:
Remrd number � Page
� � �eelpopnly �„J MaEibHome(I.C.6f.f•n
11 arry partion of tha residefaial strucMe v fhe Imd rrol mcceatlirg ore (1) aae ihal immedaldy w�un� thal �W�ae ia used to Pmduoe triwrt�e. describe the use and P�n
d Ne yoparty utifimd b V�a uimme.
a�_�a- o�- ao l-oo�, o� 3-� a�
Township
� nereny certiry ihe anove satements are we. c«recr and complem.
(nuroe. md a�t ary. sata zta Wde)
�
CoMty
�rj•�,±'{ Y'nr�ASSESSORUSE�ONLY�r•i"Fri�w��� qA �%?'TRUEtT��k�'�`Y'y.�'ASSESSmVALUE ¢HOMESTEAD�S ��"SGNONitESIDENT1ALkf,a r_5
r.�A?!.��.���3.,:na.5.^?'.`�iv.,'�`G�,C^'.,.t7�.,... � ._ ��;: VALUE . �i q' T�AT�100N.OF�TN� �"v` .VALUE � , � { . f�.�VALUE .�>< .:��
- .,z.. t. , s_ � t,. Y_�. , ..3 ..�.�'".w-
Land not eueedng 1(one) aRe irtmfldietely ' �+i�d�n.'� 5��� �����YrT'r r,;
,,,..,. _.._..
surtoundvg residential improvernents. () 4�r�..-..??�` �-x'f..i�n�,k�YZi�.�_:t� s..a.`.
�2 � �,�,
Otl�er land (p) �"�'��r-=�+��.N �t?;
,�;%�t, a��?,f`?1't,c�i
TAaI IarM (!me 1 pluslare � (g)
� "� � . '�"�ra4sc� a r� s' w''�
Residenfial improvements orMnualy �� �4) .:�t �� ��"$�* y' n*����a''x. � i,?
s� r.N..,�`�'d �,v .,..m � ..�.,
0.ssessed MoGle / Adarn�red Hartre ��e (5) �y. +`xin�s4�'�r2;23,e�tyg.���i �-':
C:'��✓."�,�`��'��',f�,ri4��f?�s,v ��:?��-.
�5, 3 gN t v�.t
Other improvements (6) 2,.4ati � ���a x
..f.�F. {-..AY �K i�
T�al'vnprwemerrts (6re 4 through Gne 6� (�)
Tdel value Q'me 3 pds Gne n �g)
1 hereby certify fhe ahove is true, wrecL and 59nauua mAsaessor Oate cigned
complete.
veiry"ug a�tion - Si�anna of t�uQimr Date signed
20_Pay20_
Lesser of 12 Homestead
Veluetion w E35,000
E
. .� .' �'v k � ,` � `a t � � � : � t ' .. `_ �, e d� A. �.� +' . � C b . � , � ' .' �'. � ', i =, `.
Date sipned