HomeMy WebLinkAboutHomestead_Kelley (9)��� � CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
q � State Form 5473 (R4 / &00) .
INSTRUCTIONS: See reverse side (orfiling insWC6ons.
FORM YEAR
Hc,o � � 6 �,.
I(VYe) �''""— • certify at on e t day f'�A ar 20%1
�I(�VJe^) occupied as our principai place of r idence the following des b d real property for which a Homestead � roperty ac redd is ere y a"vned: ,
,l�J I(We) owned ❑ Ne buying under contrad � �UL � O ZOO� .
�ave a beneficial interest in the entity lhat is liable for.the property taxes on the property and that owns the p�operty or is buying� der a� tra�/
. i�.,. �_s,
It 6uying on conVac4 Fee Simple ownets nartre
RecoMefs ofice where contract is recoided
RecorO number , � � Page
Counry 7avnship Taing tlis '(" foWn, t wnship)
1
P rcel ber Legai desaiplion
�O
It arry portron ol ihe resiAential sWCture w the tand imt exceeding one (t) acre Ihat immetliately surtountls Nat sWUUre is used to pmduce income, describe the use and portion
oi Ne property uLlaed to produce irxome. . �
I hereby certify the above stateme .ts are true, corred and complete. Signamre ot daimant �
p�qress (numbu and streeC dry, stare, ZlPCadej �
a � , " O -Z��/ �767 0
20 _ Pay 20 _
Lesser of 12 Homestead
ValuaGon or $6,000
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