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CLAIM FOR HOMESTEAD PROPERTYTAX
CREDIT/STANDARD DEDUCTION
State Fpm St73 (R6 / 4-03)
P�eaalDed bY tlro Departr�nt d Local Govermnent Finance
INSTRUCTIONS: See ie�oo aido b linp in�8uctiw�t
FORM'� 1'EAR
�HC70�
�.
DEC 1 6 2005
� �e� `�, �S�iS°��L�txr4d X.�Jiro[�rcn, zo_
I(We) occupied as our principal place oi residence the following de cribed real propeAy for which a Homestead Property Tmc Credit is hereby daimed:
'��I (VJe) owned ❑ !ve buying under wntrect
Have a benefidal interest in ihe entity Uiat is liable for the property taxes on ihe property and that owns lhe property or is buying under a conVaU.
I( buy'vig on contraa, Fee Simple ownefs name
Remrdels ofice where mntracl is recorded
Counry � iamship
Parcel nwnber Legal descriptiwi
— b —��
I( any portion o/ Ne residential sW cWre or the land not exceeOinp one (1 � aae that
of the property uUf¢ed b praduce i�ome.
County
I hereby certify ihe above statemenis are W e, corted and complete.
�ddress (number arM sheef, ciry; sfa(e, ZIP cade) �
Land not exceeding 1(one) aae immediatety
surrounding residenlial improvemenis.
Other land
Total land (line 1 plus line 2)
Dwetling
�Rasidential fmprovements or Mnually
Msessed A�bbBa / ManuFacMed Home Garage
Other improvements
TUaI improvements (line 4 thmugh line 6)
Rtal value (line 3 plus line n
I he�eby certify Ne above is We, corred, and
oomplete.
Vaifying aclion - SignaNre ofALdiWr
SignaWre of Audila
a
20 _ Pay 20 _
Lesser W 1/2 Homesread
v9ueUm or 535.000
(�)
IZ)
(3)
(4)
(5)
(6)
(�)
IB)
Signature ofAssessor
(ciry, rown,
Is Ne pm
wrrounds that
COUnty
e
SignaWre ot
$
Rewrd number
Page
question:
tealproperty ❑ MoWeHwnoll.C.6/.f-�
�e is usetl b produce inmme, desaibe the use and porlion
Tawnship
Date signed
Date signed