HomeMy WebLinkAboutHomestead_FlenerCLAIM FOR HOMESTEAD PROPERTY TAX
CRED�T/STANDARD DEDUCTION
t State Fortn 5473 (R6 / 4-03)
Presuibed 6y the Departrnent ot Loral Govemment Finance
INSTRUCTIONS: See reverse side Iar filrng instn�ctions.
FORM ��jj—� Y—EAR _lI
HC10 I I
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I(We) �/(/i�,r.�il�,� i�%`�L certify that on the 1st day of Maroh, 20
I(We) occupied as our principal place of residence lhe following described real property for which a Homestead Propert�r�dit�is p�,b'y daimed:
❑ I(We) owned ❑ Are buying under cont2ct
' Have a benefidal interest in lhe entity that is liable (or the property taxes on the property and that owns the property o�is buyingup4]er�a contracl.
If buyinq om m�uaIX, Fee Simple ownefs name
RecoMefs olfice whera cantraG is recordeC
Counry
Tovmship
disUict (city, town.
/� a -�a ��=�a
If any portion of the residenUal sWCWre w the land nol exceeding one (1) acre that immediately surrounds
o( the pronerty utilized to produce income.
/7
% ��.(�,c,P �
vi c
Rewrd number � Page
Mobila Homo (I.C. E7.7-7) .
is used to produce income. describa Ne use and portion
?� �� �� -�"�� f �z`"�"s� ��s,�`,�,��-¢� �'"TRUE TAX�� , ASSESSED VALUE �HOMESTEA� �'��NON ESIOENTIA��
ta -��„YASSESSOR I1SE ONLY .. �.-.4 '-�i+
�'�5..�:£�isYr. i>_a. ��?.1:%,t:: �as�e`a.R nu. -�-.�a�VALUE,��'�„-t'ti �' r/iT-700%'OFTN� � .�;VALl1E� �'µ r:-�v�.'s'i 9.VALUE�� �. �`
Land not exceeding 1(one) acre immediately ���� "x�+,? �:��� f<7
surrounding residential improvements. (�� '��'� �� ��*; s P•`
;,`F.'��� sy, i.. �.n.�,
Other land (z) ��y���,���-
:?.� � ��'�
Tdal land (line 7 plus line 2) (3)
.�„�._ ..�a,.. . �-��.•�.��
Dwelling (d) �:. �' , �v �:�' � . P;yrYjr"6
�Residential impmvements or Mnua�y ' �'^�� �. a:: ;•__ _ �'.x�i
Assessed Mobile / ManufacYUred Home Garage (5) :�,,,,p� ..'�� ` F-.
�n�fn` ,' �.tie,4't�-��
�r1:'=;'iT: r:� '
Other improvemen�s (g) .�._ ,'-��'r'� a"�u��r��
;;.z.�x.: �i,%;�
�_ s-.�_, 4....i.,a
Rlat improvemenfs (line 4 fhrough line 6) (�)
kial value (line 3 plus line n (8)
I hereby cert'rfy Uie above is W e, corred, and Signamre otnsseswr Date signea
complete.
Verilyity aclion - SignaWre ofPLditor Date signed
20 _ Pay 20 _
Lesser of v2 Homes;ead
ValuaUOn or E35.000
-a �-a