HomeMy WebLinkAboutHomestead_KixmillerCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Sfeta Form 5173 (R6 / 403)
Resvibed by Me DeparNmnt d Local Govemment Finar�ce
�NSrnucnoNS: s� ��rs arw w,�q;�m�,�
� �e� —�`�—
I (We) occupied as our
_y �
�ORM � YEAR
cao/
OCi 2 � 2005
`J „Q/!.ry /\ 1JL.J'iV COUNTY A �r��Tf��
� rtiry lhat on the 1st day o� FAartti; 20_
described real pmperty (or which a Homestead Property Tac Credit is hereby daimed:
I(We) owned ❑!ve buying under contract
Have a benefidal interest in ihe entity that is Iiabie for the property taxes on the property and that owns the property or is buying under a wnUact.
if buying on conVap, Fee Simple owners name
ReroMefs ofica where conVacl is recorded
`-�, ^�.` '_ a �' �� +�'` 'u B �� ; �"T. fi' t .° � . �� `'�. � c � i ,� `-`. z�' �. T
Caunry Tamship
Parcel num6er
(/ � � —Cl 7 0( / 7 — YJ I / \ rCf
I( any portion of Me residenUal sW cNre w Iha land no�
or the prov�Y uUiized lo produce income.
(1) aae l0at i
�%� �
Record numEer � Page
7acing aistrict
Is the
I �ieal D�opery ❑ Mobile Homo (I.C. 6f.f-7)
surrounds ihat s W re is used b D�duce incrnne, desmbe Me use and portbn
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�'�=�.�-'�-����"-zz���v:,s�PROP.ERTYOWNEDIBYCL'AIMANT;INiOTHER'COUNTIES,.�__ -„�.,z�.,,� � �
County Tavnship Counly � Toxnship
I hereby certiy the above statements are W e, correcl and complete. Si re t daimant ,, ' �J
� - %`��
�dress (number and sVeet, city, stafe, ZlPcode)