HomeMy WebLinkAboutHomestead_Miskell (16)�; CLAIM FOR HOMESTEAD PROPERTY TAX
' CREDIT/STANDARD DEDUCTION
� S�a�e Fwm 5473 (R6 / 1-03) /
Prestribed Oy lhe DeparUnent ol Local GovemmeN Finana� �
INSTRUCTIONS: See ievcrse sidc (or �iling insfyuylions.
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, Nve� �r�.�,�� —�.. �r—X�c-ci� I V I�,) p� d
I(We) occupied as our principal placc of residence the (ollowing desct�tL(�al property (or which a Homes
❑ I(VJe) owned ❑ Me buying under contract /�' "�
' Have a benefidal interest in Ihe enfity that is liable for the property taxes on �he property and Ihat owns
If buying on convaIX. Fee Simple ownefs name
Remfdefs olfica where conirad is recorded
FORM YEAR
HC10
1
on the 1st ay df M_a�rch, 20
� �rtyTac'Credi��is'herebqdaimed
FEB 0 6 2004
�erty or is buying under a contraU.
i /
ord nu ber'v Page
�nN �/� n n Tamship Tating tlisUict (ciry, tawn. fownshi
SlAlO I��
Parcel nu�nbe� � �� al description O I property in quesliw�:
n
lJ �� � �] Real property ❑ Mobila Mwno (l.C. 61.1-7)
H any portion ot the resi0enllal atructure or the Wnd not exceeding one (7 ) aae Ihal immetlialety wnounds Ihat swcture is used W produce incwne, describe Ne use and portion
of the properry util¢eC to produce income.
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.�/—�.3 �
County Tavnship Couniy
I hereby certify the above statemenls are W e, corzed and complete. Signatw
Pd�ress (num6er aM sfree4 ciry; sfate, ZIP code)
�
�"�" y+ "a"��'}�•'�9"'�"���i����TRUETAXf� ASSESSEDVALUE HOMESTEAD�;r�- � �°��s�
� A,SSESSORUSEONLY r�i?.2�'�t.�4'-� ��r 3�I � �eNON-,RESIDEN�TIA�.¢p��
x �. .i�F,��i?rf'� h�y_,�ri�,s.-�:y ,��VALUE};. . �._ ��,AT 100Ye OF'TN �ar VALUE,�<."„��-. ��.'�'�a �VALUE .�`,.�� 'vc �
Land not exceeding 1(one) acre immediately '�"��Y. 1��".r�x"�.�� i�
suvounding residentlal improvements. �� � ?!,�'��'� 3��.,:� `� �(
Other land . `��� � �'� �� �
(2) �`�4.��.- � _ -'�
Tdal land (line 1 plus line 2) (3)
��r r-,:+_-..m,�. w.i v:,, i
`i•. '"a aS t�+.3�;�?�� .r :v3
Dwelling (4) �.. ���° ,is��-r
Residential improvaments or Mnua�y �Y���(�.�-��. x. '�.:aYz'��.�t�
Kssessed Modle I ManufacNred Home Garege �5) �.��'�.'R`� Z`�:��-5 i:z'�"`� ``��
�.'es�� i� `t���
Other improvements (g) '���-?�
??��EC�e:�ss:a-`�
TUaI improvemenis (line 4 fhrough line 6) (�)
Tolal value (line 3 phs line n (g)
I hereby certi(y �he above i5 We, corred, and Signature otASSeswr Oate signed
complete.
Verirying aclion - Sgnature oftwdilor Date signed