HomeMy WebLinkAboutHomestead_Goldbach (5)- CLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Stete Fortn 5473 (R614-G3)
Pmsaibed by the Departrne`rt of �oral C,ovemment Finance
INSTRUCTIONS: See rererse side 7or filing inshucfions,
FORM �� YEAR
HC10 �
� ce� r r'- _ � � . _'
I(We) � certify th�l'bd�h�lsY'd5�tl�arch, 20_
I(We) occupi s o r 'ncipal place of residence lhe following described real property (or which a Homestead Property Tmc Credit is hereby daimed:
❑ I(VJe) owned ❑ fve buying under contract �7ja� ,Q�
�Have a benefidal inierest in the entity Nat is liable for fhe pmperty taxes on the property and Ihat owns t�B�04f�X7�7l�Pr�WDdbOat�onVact.
If buying om m�irdd, Fee Simple ownefs name
RemrAefs ofica where conirad is
Rewrd number � Page
�+nty Tamship � 7ating disUict (city, rown. Pownship) � �
P n ber
//�q) /� �e d ^P Is Ue property in question:
� V �(�J ❑ Real property ❑ Mobile Homo (/.C. 6f.7-7)
If any portion of Ihe residential sWCture w the land not exceeding one (1) acre Ihat immediatety wrtounds Ihat swctura is used b produce income, describe Iha use and portion
ot ihe prope+ry util¢eA tn produce iixome.
���`� SSESSOR (1SE ONLY ���'� �TRl1E TA7( �'° ASSESSED VALUE e HOMESTEAD �"` � � NON _RESf�ENTIP.L ���=<
�fj�```�.,,��:<g '_ .i , w �.�_.i .? `��� n VALUE�''�- ATi100%�.OFT7V: �?VALUE a"��.35 fa1�'VALUE�j�^ �.�
_.ff ts,.s..-. �'fi._ h.,S't .. A Y,t£d� .� _.e�#'4 r�..+„rar'1+..,x.-,-
s. _ _ __ .-.._ ...a-.....� .,-.,
Land not exceeding 1(orte) acre immediately �=7 "`� �„se?x;° iz3,�a ;=-5"T
surroundin resideniialim rovements. (�1 ��,'�"�F��' '� ` �`'F '�'"�
9 P ;-'2`��+e�� ����'�::.�.'�'�,...��^
r, �:�-r3�=�ap; .
Otherland "�"='��: '
(2) r Ys?:�s,r,s;<x-�:r:fi
- .:,'-.;.A��.'�s;
Total land (line 1 plus line 2) (3)
9 l � � ��Tryi.�.��4 !J' iT f�a� �'�,1��
� � ., �'�
Dwellin 4 ;�:��� ��������-'
Residentlat (mprovemenLS or Mnually
Assessed Mobiie / Manufaaured Home Garage 5 %-,�'��" �' ��'"
( I -.--.M�„�H�,��,� `_ � -"�1'��
�� � -
Other improvements (g� t� '����5�r��,, �i`r
' t I"`�;�"��
Tcial improvemenLS (line 4 through line 6) ��)
Tttal value (line 3 plus line n (g�
I hereby ceAify the above is We, correct, and Signamre ott.ssessor Date sgned
complete.
Vaifying action - Signature oflwdimr Date signed �
�'�'�.�h�.�=�.; �..'�JC� �'°:�..s�^'€�`�"�'��'�'''�7it..i�iSTAN�ARD:DEUUCTION�AL'LOWAIJCEtr �x:;�•.s� �: q� �; —ry.
,�.. �, a..a .... . -�'.i:�_7�.3'"�'a�.'��v..;i'���;'.��3i`.7?�.�.'4,'�'�„��`.�.e��"Y'-...'^.�
20 _ Pay 20 _ .
L�sser of 1/2 Homestead
va�uaLOn or E35,000 �'
SgnaWre of Auditw " Date signetl