Homestead_Walters� CLAIM FOR HOMESTEAD PROPERTY TAX
- ' CREDIT/STANDARD DEDUCTION
t- -� Sbte Farm 5473 (R5 / 10-01)
�•� Prescribed by Ihe DeOaNnen� of Local Govemment Finance
INSTRUCTIONS: See 2verse side lor (ling instructions.
'�`'"e> 1�.�9.d i� Y �' 1�--�t�t1� I�,�J V-�C/�a.t -c�
I(VJe) upied as our principal place of residence ihe (ollowing descnbed real pmperty tor which a
I(VJe) owned ❑ Me buying under wntracl
_ FORM YEAR
HC10
����
that on ttie 1si dav of
ciasoN
Have a benefidal interesl in the entity that is liable (or the property taxes on ihe property and that owns lhe property or is buying undar a wnVaIX.
If buying an conVad, Fee Simple ownefs name
Recorders ofica where mntrad is recorded
Counry
�
Tamship
Is Ne pmperty in
Remrd number
Mobile Homo
Page
H eny poRion ot Ne residenUal sWGUre or Me land not eaceetlinp one (1) aae that immeCia ty surrounds Ihat swUUre is used b produce inoome, desttibe the use and portbn
af the propery uGl¢ed to produce income.
°� �O �/o� - D �`-Ti'G�- cx� �� k-�� "Q�
�o���Y
I hereby certify the above statements are We, correcl and complete.
Addreu (numbereM s7eet dty, atate,
\ /SO S/ !/1/,'/JcrJ 6r
/7'i4cc�an � L/N s��67�
�� �� E� �� Y -'�`�'�` x� �'TRUETAX�� �. ASSESSED�VALUE �F{OIAESTEAD r NONAESIDENTIALj, ��
,�n. .; . .. ���. ���-.��� _ VALUES - �`ATs100%yOFTTV-�s �yt�VALUEt"- 0 �� ... r-(,'i+-V/1LUEr-� 3���
����� �..+_:-.__....��,,z.. _ ,...�.
Land not exceeding 1 (one) acre immediatety � � �'``�� �` `" �" `�"
suvounding residential improvements. �� � ��� ``i `'j��'k���„ �,�. '' B _
(C++� rS�:,t-��"s-, .
Ofher land (z� � x� .4 ;_;�
.��'��'�
7dat land (line 1 plus line 2) (3)
Dwellin9 (4) s���`�`�'����7���
Residential improvements ��`F" � 'Y°'Y'" '��' �""
i `4 � T" a f"r
Garage (5) :'- � _r'"�i „�cP`£�y�%
'Gg� ;- . _ ,�`
�r.��. �=t �...$.K.t' t�
Oiherimprovements (6) � ��,�*; �: ..��
..3-:_-..'Y
Tdal improvemen6 (line 4 through line 6) ���
Tdal value (Gne 3 pl�s line � (g)
I hereby cerGfy fhe above is W e, mned, and Signature otAssessor Date signed
completa. "
Veritying action - Sigiature o(lwdilor Date signed