HomeMy WebLinkAboutHomestead_Sullivan (8)CLAIM FOR HOMESTEAD PROPERTY TAX
- " CREDIT/STANDARD DEDUCTION
t �� Slata Fortn 5473 (RS HO-01)
�•� Prespibed by �he Deparhnent of Local Govemment Finance ^
INSTRUCTIONS: See 2verse side /or �ling instructions. ��J
FORM YEAR
HC10-
��ti� �w, �
�J �
I (We) ' /�(J���� \ � i . � ,r,ertify`-t �at,an We 1_„ s `t d-a�:�o_{Xarch. 20
I(We) occupied as our prin I place of residence the f lowing described real property (or which a Homestead'P,roperty Tac,CrN,ibis hereby daimed:
❑ I(We) owned ❑!ve buying under contract �
' Have a benefidal interest in ihe entity that is liable for the property taxes on the property and that owns the property or is buying under a contraU.
If buy'u�g on conUaq, Fee Simple owners name
Remrders ofice where contraq is remrde0
County
Tavnship
�i.�.=. p3 ►s9-� �.o�� �,��:4.�►,�.
N any poAion of Ihe resitlentlal strucWre or the land not exceeding one (1) aae
of the property ut�ized b produce income.
County
Tavnship
I hereby certify the above statements are We, wrrect and complete.
Z/Pcode)
RecorC number
T�ing disuicl (dry, fown. fownshiP)
Page
I Is the propcvly in question:
❑ Red D�operty ❑ Mobile Homo (/.Q 61./-n .
wrrounds ihat swGUre ia used W produce income, desttibe Na use and porUOn
County
u?6?O
���� �`°�`y`'-"'T'��'��'°"�� � "`�''�-cj.�'�TRUESAX+'� �ASSESSED VALUE �HOMESTEAD`` -NON-RESfOENTIAL"�
g.ASSESSOR-USE ONLY,�,��/ �.?^ z YALUE�� gr "AT�100%�.OFyTIV� ��y,�`�. V/iLUE�� �� � VALUE'kF�ti.'.`�
#� '.,�. T.'x.�au� °. �dN�'d�"s= m. -S� � �. � „a��:'L ....f.s.,. _ :�
Land nol exceeding 1(one) acre immedialely �.,,���,���*��`'r�' '. `
suvounding residen6al improvemenis. ��� ��:'�k'�_��,�
z�wu:•- 3'ti"rlrti .
Otherland ^'=°` t= f`'"
z - ��y�_.''� .. 5'��.�'
� � ,�:�4�T6Xi.f���3Sa
Tdal land (line f plus line 2) �3�
Dwellin9 (4) '�4 �i=�,� x��.'t,�,�_sr��
Residential imprrnements �'£'"a��'°'�"
.r-�'-g s����s���-�'-��'r�`V'.
Garage (5� �,. t�:'. �r'��Y ,t�.���.':.
.�• �
Other improvemenls (6) �,�.`�l� ���
x t.l.�"'�,C��`, 's
Tdal improvements (line 4 fhrough line 6) �7�
Tdal value (line 3 plis line 7) (g�
I he�eby tertify the above is We, [orred, and SignaNre o(ASSessor . Date signed
complete.
Vai(yiig aclion - Signature of Audimr Date signed
""`��'�'v - ` �`" `�"�' � 77� 'S�' '�`�� ,,;STANDAR�'.DEDUCTIONALLOWANCE�c'i+'�,"n�m � -:v� p+. ' �, s ' �-a�-,
•:sw��'�A��-�<� �?..a�?�'3;4', --` _. .._ ra,�-�.>�..a���3s��t- .�s.•i��'�f.�'±�?�__-�
20 _ Pay 20 _
Lesser of 12 Homestead 5
Valuation or 56,000
SgnaWre of Auditw ' j Date sgntd I I Q�
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