HomeMy WebLinkAboutHomestead_LangeCLAIM FOR HOMESTEAD PROPERT/ TAX
CREDIT/STANDARD DEDUCTION
t Stete Farm 5473 (R6I4A3)
PresuibeE by Me Departrnent of Lorai Gwemment Finance
INSTRUCTIONS: See rererse side for filing insfix.tions.
FORM h� YEAR _
1u �
HC10
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,. . --.. . ...E-};nsz'?=�=?: '�'S.--..-- . --
, N,,e)�.�.�, �'� ��Q�.`�(.�-L�R APR 1 7 20U!
certify that on the 1 st day of March, 20_
I(We) occupied as our principal piace o( resi the follo ' g descnbed real property for which a Homestead Pr, operty T�c C� is hereby daimed:
yy/ ,�S
❑ I(VJe) owned ❑ Are buying under contract O'��
� Have a benefidal interest in ihe entity that is liable for the property taxes on Ihe property and that owns W�i�r�y�n5 �uNng u�odea�r a contract.
If buying on contract. Fee Simple owners name
Recordels otfice where wnirad is recorCed
�.�._��.'-��`� 4ai� °.'a '��%:���s���
County - 7avnship
I/ any poAim of Ihe residential sW cWre w the IanA not exceedi� ona (1 j
of ihe pro0erty uli0zed W Fuoduce income.
EiSUic� (tjr1�; fown,
Is ihe property in question:
� p ❑ Real pmp
ihat immediatety wrtoi
3��13�
Rewrd number
❑ Mobile Homo
Page
6 f.
that sWGUre is used b produce income, describe the use antl portbn
�' -43�5~,v�'Yf��T�':''�i �"'h £r�,c,�" -hY °'6� E 145F� w t �fY - . . ti� �r aa:vaaP . .
;���(r-��cs��A .S�ESS�ORUS�E,_ONLY���� �����,�VAL.UE�� ATE00%OFiTN ��H�VALUED�= ���VALUE�������
u' �.+�'.,-,. ,�� �� � �'� ;�
Land not exceeding 1(one) acre immediatety � t'�' � � r�t � � q
surtounding residential improvemenis. (� ) ����,,' kL , ��`;*} �
. fi ._.3 z��.:��i�a
Otherland f'���`�=_3 ��`'
(2) Ff'w,��A��_�...'�5'
'- �. .,:"
Tdal land (line 1 plus line 2) (3)
Dwelling (4) � � { ��f;� � ����
i .�''.t:'�`���t"4��, � '�'. �L,�a�:L�:�S
Residential improvemenLS orMnualry
Assessed Mobile / Manufaclured Home Gara e �r �'t`'•`�"�i'�- �
9 (5) � ���w''�' . " . �ii 3�1�'*'�
'-;^:".�_-�_-_: i
Other improvements (6) :��'Y=af�����
,,.'_ ��'?'..�,�'
TUaI improvements (line 4 fhrough line 6) ��)
Tcial value (line 3 phs line n (g�
1 hereby certify fhe above is We, coneIX, and Signature otAsseuor Date signed
mmplete.
Verifying action - Signature oflwtlitor Data signed