HomeMy WebLinkAboutHomestead_Rigglerl� YEAR
;� CLAIM FOR HOMESTEAD PROPERTY TAX � H po t �
CREDIT/STANDARD DEDUCTION � �
� ♦ Staie Form 5473 (R6 / 403;
Prescnbetl by the Department ot Local Govemment Finanu:
INSTRUCTIONS: See �evasc side loi Iiling inslmr.finns. m C R 1 5 2005
�?;?�= i � -- �K� �, .i.;.•.a-r�-;: - . �.••: =' '� CERTIFICA710N STAlEMENT.. . . . ..
'��. I(We) certify IjYat�S'fFfe�t nofT�arch, 20
I(We) occupied as our principal place of residence the following described real property ( ch a omeste v�4T0�re0�5�fiereby daimed:
����d�r�
.� 1(VJe) owned ❑ Are buying under contract
�� Have a beneficial interest in lhe entity Nat is liable for the property taxes on the pwperty and that ovms Ihe property or is buying untler a contract.
II huying on contract. Fee Simple owner's name
RemNe�s olfice where contracl is recorEed
Cwinty Twvnship TacinpVi5lr�tt (c
yJ 1
Parcel number � I description 1 Is Ne
-033 - }- i - - b
If any portion ol Ue resid �Ual sWMUre or fhe WnE no� axceeding one_(1�cr9e, that immetliately surmunds
ot Ne properry utilized to otluce inwme. �
Rewrd number
Page
township)
J
in queslion:
f`Real property ❑ Mobile Homo Q.C. 6f.1-7)
tura is useA lo produce inwme. desaiba Na use antl portion
rm�T�nsk" ASSESSOR SE ONLY � � TRUEYAX ASSESSED VALUE �-HOMESTEAD� - NON-RESIDENTIAL
:_� .
i:?.+u�r�..<.. .-.: S-.._...:a,-�- ..: .t- - � - �� . ' VALUE AT 100%OF,TTV -,' ' VALUE �- � ;'; . _.... `�i'S: VALUE� .
Land not exceeding 7(one) acre immediately '''Y'r�>= °""' =: - �
(�) ..� ... - .
surrounding resitlential improvements. . . • ' .
Otherland (2� � - -
TUaI land (line 7 plus line 2) (g�
Dwelling (4) ,'.:�.,t_s..'",:..r..._; �: .:
ResidenGel improvements or Mnualty -. �' yA ; . _., _" ; : " _
hssessed Mobile I ManufaUUred Home Garage 'E �' ` : ��
(5)
Other improvements (6)
Rial improvements Qine 4 fhrough line 6) �7)
Ttial value (line 3 phs line � (g�
I hereby certify the above is Irue, conect, and S�gnawre ot Assessor Date signed
complete.
Venlying action - Signature oflwtlitor Date signed
,._.�r.d`C_ " � ' %�- - ='-�.STANDARD.DEDUCTIONALLOWANCE"'�'- � � � '�
20_Pay20_
Lesser of 1/2 Homes;ead �
vauauon or 835.000 5
Sgnature otlwditor - Date signed