Homestead_Zelko'
° CLAIM FOR HOMESTEAD PROPERTY TAX
. } CREDIT/STANDARD DEDUCTION
Stafe Fortn 5a73 (R8/7-07)
I�,• � Rescnbed by Iha Department of Local Govemment Firiance
INSTRUCTIONS: See reosrse side /or filiig ins6ucfions.
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�(�✓e) certiry that on the tst eay ot March, 20_
I(We) occupied as our prindpal place of r idence tlie following described real property for which a Homestead Pmperty Tac Credit is hereby daimed:
,� � I(We) owned ❑ Are buying under contraU
Have a benefidal interest in the entity that is liable fw Me property tazes on the property and that owns the property or is buying under a contrad.
If buyNg om m�Uad, Fee Simple ownefs rmme
Recadefa d5ce where canVad is recortlatl
Counry
TawnsAip
Record number � Pape
Parcd number L descnpGOn �.s� Is Ihe properry in quesGon:
. e� ��,✓,� �� � ❑ Real property ❑ Mobile Fbme (/C 61.1-7)
If arry portion of Ure residerNal sUUdure a the Wnd not �ceeding one ( ecre ihat imm�ately wrtounds ihel structure is used to produce Income, describe Ure use and portion
of Ne prnpBrty uU5zed b produce inmme.
a.ia' (/- /p� - /o3—OOD. O!c!a-U •t�
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Landnotexceedingl(orre)aaeimmediatey ,c,^+{ ���.�.:r, i .:�.�:�...?,:',
surrounding residential improvements. ��� ;,; �' "a •:; �?s�� �'•.+-- -
Other �and (g� - �.: :
.,".'S: ',.
Tdal land (line 1 plus line 2) �3)
�S 4 � •
DwelFng (4) s� `±.�,
Residential imprwemenks or Mnually �"*�,, -.�� y k'�:�
Assessed Mob�le I Manufac¢ired Home - �. �: -"
Garage �5) �' S ..�.�rr :-..-_ �. ,
__ - ;:;.; _
Ofher improvemenis (6)
Tctal improvements (line 4 thiough �ne 6) (7)
Tcfal value (line 3 pfus lirre n (g�
I hereby certify �he above is We, cortecl, and Signature ofASSessor pate signed (monN. tlay, yea�
complete.
veiry�� ae;a, - si�rew� of num�w oa� sre�ed (�nm. mr. rea.�
�J pay 20 _ q5.ppp tor 2007 pay 2008 42.000 for 207 0 pay 2017
Lesser of 12 qq.ppp for 2008 pay 2009 41.000 for 2011 pay 2012
Homestead VAuation
a 43,000 for 2009 pay 2010 40,000 payable after 2012
s�eorn�,mm. n
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oa+e signea (n,mfh, ear. r��
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