HomeMy WebLinkAboutHomestead_ArrickCLAIM FOR HOMESTEAD PROPERTY TAX
n k CREDIT/STANDARD DEDUCTION
` SIa1e Form 5473 (RB! 7-07)
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Prescnbad by Ne DBpaMrerri of Laal Govemment Finance
INS7RUCTlONS: See raosrse side /o� fidng instrvctions.
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MAY 1 5 2009
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�(we) certify that on y of ch. 20
I(We) oaupied as our prindpal place of residence tlie fdbwing described real property for which a Homestead P fs� � r{�ed
�I(We) owned ❑ fve buying under contrad
Have a benefidal interest in the entity that is IiaWe for Ne property taxes on ihe property and that owns ihe property or is buying under a wntraG.
If Wy'u�g on oontraq, Fee Simple mmels name
Recartlers office where conVad is recordad
Caunry Tw�nship
� If arry porlion of Iht
of Ihe property NiB:
Record number � Page
(cily, town, famsNP)
Q=cripL'pp n I Is iha properry in quesUon:
7 LOC b
❑ Real property ❑ Mobile Home (!C 6-7.7-n
nol exceedirg one (7) acre Ihat immediately wrrounds Ihat siructu2 is used to p�oduca inwrtre. descnbe Ure use and portbn
f1'�ir�,, .:
I hereby certify the above sfatemenfs are W e, cortect and complete.
,Idress (number arM street aty, sfete. en0 LP cade)
land not exceedirg 7(one) acre immediatey
surroundirg residential improvements.
Other land
Tdal IarM (line 1 plus line 2)
Residential improvements w Mnualy �n��
Pssessed Mobile / Manufach�red Home
Garage
Oiher improvemenLs
TUaI improvements (line 4 through Orre 6)
Tdal value (line 3 plis Gire �
I hereby certify the above is We, corted, and
complete.
Verilyirg aclion - SignaWre of AuAlta
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SignaWre of Assessor
�0 �Y Z� _ q,5.ppp �r 2007 pay 2008 42.000 for 2010 pay 2011
Lesser M 12 qq,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation S
« 43,000 for 2009 pay 2010 40,000 payable after 2012
Signatura Nlwditar
Twvnship
syned (rnwiN. day. yea�
Date signed (monN. daY.Y��
Dale signed (monN, Cay, yea�