Homestead_Weiss�; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
/ StateFwmSd73(R6/403)
Presriibed by �he Department ol Local GovemmeN Finance
INSTRUCTIONS: See reverse side lor /iling insVUUinns.
FORM YEAR
, 9 HC10
i � .i �--I t
� �J ��..J
DEC 2 0 2003
�(we) (� YC�/��� (�/! f/_!/.CXJ �0 QO LlL1J c�,Nat on 1 e�151 day.of Mai`cF�..20
I(We) occupied as our principal place of residence Ihe following descnbed real property for which a Homeslead�PiopeityGac�Cre�t isiheieby'daimed
� 1(We) owned ❑ Are buying under wntracl .
, Have a benefidal interest in ihe entlty that is liable for the property taues on the property and that owns the property or is buying under a conVaU.
If buying on coniraq, Fee Simple ownefs name
Recordefs afice where cOntracl is recorded
=� ?�%.itir'��.�.'�s'sr�'.>.k2�`v��ne'�t�r`+�
County � � Tamship
Ta�ing
Record num6er � Page
Narce� nym be0� /// L���/Lf LCL(� /// . I Is Ue ProP�'jy�9� DropertY ❑ Mobile Homo (/.C. 6 f. f-n
( Y�; �q�
If any poNOn ol Ne residentlal struchire w the land not ecceeQin�e (1) ace at im � ty wno/�� Gure is used to protluce income, desviba ihe use anC portion
ol ihe ProP�7 utilizetl tn Woduce inwme. ( // f
yi �
°��-���� `��/ oa.3 97/-c�a�
co���Y
Toxnship
I hereby certify ihe above statements are We, correct and complele.
(number and sheet, city, s(ate,
County
TavnShip
r � F �''��"���"�;`��'"'�'`�� .. �sTRUETAX +�"� ASSESSED�VALUE HOMESTEAD NON-YRESIDENTIAL h
5��. � ASSESSO,�SE�ONL, w� � '�^#.��%� ? s V.ALUE �� �ATx700°h OF�'TN-� ��,VAL'UES � �����-L'-�,..VALUE`.,3'e'.�^'��
Land not exceeding 1(one) aae immediatety ��'"`��.. `���r ��.�
surroundingresidentialimprovements. (�� ���.,� �Z'�;"�-.���:.
Other land (Z) ���=� ""t r'�;=
,���
Tdal land (line 1 plus line 2) (3)
Dwellin9 (4) ' ��� � h'�'� ����'t
Residential Improvemenb or Mnually �����°s��'�'��'�
Assessed AAobib / ManufacNred Hame Garage (5) �,��� _•, K ,.4+'��'��
�.. k#� s�-=�a,
� �� _
Otherimprovements (6) �� ��:��
?'�4.�w� -�a . ;:�
Tdal improvemenfs (line 4 fhrough line 6) (7)
T�tal value (line 3 plts line n (g�
I hereby certify the above is We, corred, and Signamre olAsseswr oate signed
complete.
Veifyirg ad'wn - Signature ofAudiWr Date si9ned
"�,�����-.r��r,��,`c_�,��r�:srn►+oaRn:neoucnoN�auowa►ice:�'�`�„�'k�' ,'��"-'--''�"�:��.���.�`.���.�
20_Pay20_
Lesser of 1/2 Homestead
vauaton or E35.000
5
Signature oflwdrior " Date signed