HomeMy WebLinkAboutHomestead_Davis (19)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S1eM Fortn 5r73 (R6 / 4-03)
Resaibe0 by Ne Depm4miri d Loml Govemmeirt Finmxe
INSTRUCTIONS: See ie�eras alds br �p i�sbuctions.
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V��
R YEAR
� cio
NOV 0 9 2005
' M'e) ' '(-5/Cf/1'``�Cl `Pv'i�s`�i`�°���r}1���'ii4������n, 20
I(We) occupie a our principal a of residence the tonowing described real property for which a Homestead Property ac Credit is ereby daimed:
❑ I(We) ow d ❑ Ar� ying under conUact
' Have a benefidal interest in ihe entity tha� is liable for the property taxes on the property and ihat owns the property or is buying under a contract.
I( byvg on wnUaIX. Fee Simple ownefs name
Counry
County
o1fiL8 WherB LOnh3Gt i5 reCOfdCd
Tamship
f Ne residenlial sW cture w Me
ulilaed tn produce ir�come.
rown.
Is Me
axceedinp one (1) aae tAat immediatey wrrounds Ihat
County
I hereby certity ihe above statements are We, wrrecl and complete.
stieet, dry; s(ate, ZIP
Record number � Page
al property ❑ MoMle Homo (I.C. 67.1-»
is usetl tn protluce income. desaibe Ue use and portbn
$`������"� f` �''t�'�� ;TRUETAX� ASSESSEDVALUE �HOMESTEAD�`� S�` ��"NON-RESIOENTIAL4�=�
ya� *^-• yAS5ES50R�USE ONLY 7 ` �VALUE,x, .�ta� ;"ATy100°/a'OF�TN� ��:VALUEcp� � �' :�.,',r�V/1LUE a�; `�.-;f�
a +s...�'��Sv�i�'.�^�': Ya�t�ST'�2�°,?$?��"s� �f�t�'�.' �
Land nol exceeding 1(one) ave immediately "�,�, s`} � r�., II"��_?� ��;.
� z�..:
surrounding residenGal improvements. (�) �� n "�''r$`t � _ �� .��
. vrt:� �`,`-=E.�t_
��y: ,r' �,
Other land (p) ����= ,'��
.- �4'ir6t�'•, t'�F�
Total land (line 1 plus line 2) (3�
.s �,,;�' .<a r s:+ s�•�-'-�
n
Dwelling (4) ��'�K��J��° � -,��y�
�Residential Improvements or MnuaOy ,�,� � �„,.
Aese»ed Abbila / Manu(ac9ned Home Gare9e 5 ��ir�`'�� g,3°'"'��"` ���g"��.`s.
( 1 � �f:i�''�':�'��`�'�is�;Y�� �'�?'#�?+<d!
z� �r`' �- 'ii��:)
Otherimprovemenls (6) � �"``g �r ��3,,`�t ��
_ e !`"s�?`F�"rr„�l'.�.3
Tdal improvements (line 4 fhrough line 6) (7�
Tdal value (line 3 plus line n (g�
I hereby certi(y the above is We, correcL and Signamre otnssessor �ate signeE
complete.
verirying aclon - Sigreture otAUaimr Oate signed
'���'�'t3�'�,.-'����'w'--..''x':�7"�*�c3�u.u�2_�.3=,�i'��x-�.,STlWDARD'.DEDUCTION'ALCOWANCEt;��!�':T-�'x 3'.�.,�','''a��'A�-r�rt.,'f�"`"-����i'')'.�.,°.�_'=
_ _
20 _ Pay 20 _
Lesser of 12 Homestead 5
Vauauon a f35.000
Sgnahre otNWitw " Date sgned