Homestead_Willis (5)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stata Form 5173 (R6 / 4-03)
Prasuibe0 by the Department N Loral Govemment Finance
INSTRUCTlONS: See �everse side /w �liig inshuctions.
FORM �+`� ` YEAR
HC10 �
T ;
� T � �
�
� �.
- 1.;:,�; `,' �nnF., ,,�-��;x�'� � -, . _
��e) �� �� certify Iha�/t o"n� the tst day of March, 20
I(4Ve) occupied as our principal place of sidence the following desuibed real property for which a H�µtehadcPrap2ay Tac Credit is hereby daimed:
❑ I(We) owned ❑ Are buying der wntracl � V Y AUp�TOR
�a���N COUNT..
� Have a benefidal interest in the entlty that is liable for the property taxes on the property a owns the property or is buying under a wntract.
If buying om m�Uad, Fee Simple owners name
Recortlefs ofice where coniract is remrded
If any
ofihe
Tw�nship
o( Ne residenUal sWCfure w the
y util¢ed to produce inmme.
Record number
propeM ❑ Mobila Homo
Page
exceeding one (1 � aae that immediatey surtounds ihat swGUre is used to produce income, describe the use and poNon
��`X �' }"ipSSE OR USE ONLYf �`� ���``��' i �yTRUE TAX��vt ASSESSED�VALUE ,�HOMESTEAD �NON-RESIDENTIAL�$
�,,
�..r-.�.L. i�i.�...�.=�•�F sw,g �<. n�y :, �" �> wVALUE � rv AT�100%OFT7V A="VALUE �.'f' � '�-
- 3?: ���.... Yt°se w� ..r.z.. .,:4 Yc�.- ,_..r�.,� r� r�.�" .-},.�4;x,VALUE f��
Land not exceeding 1(one) acre immediately ' ;;3t�,1����-,�T+ ,y,������ F
surroundingresidentialimprovemenls. (�) •;?-,���`,�,s'�+'-„�����'
t�F
Other land `�` # � Y
12) r, -�.°����-''_'���
Tdal land (line 1 plus line 2) (3�
•-SV Et+F r,rc .�c.� :.
' Dwelling (4) fR'�.�a.��€ ^�'���"����
Residentiel improvements orMnuaUy
0.ssessed Mobile / ManufacWrad Home Gara e (� ���.. ���t ^' i�'•�h��
9 5 ,�`.'''"'�����i�����
Otherim rovements ��'T �"���=
P (6) x ��?���s^�n�
Total improvements (line 4 through line 6) ���
Ttial value (line 3 plus line � (g�
I hereby cerU(y the above is W e, carreG, and Signature of Assessor Date signed
complete.
Verityirg action - SignaWre oflwtliror Date signed
20_Pay20_
Lesser of 1/2 Homestead
w 535.000
Date s@t+�y� � 1
V `7,...