HomeMy WebLinkAboutHomestead_CroosCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION H o
State Form, 5173 (8614-03) FI
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions. JUL 3 ) n m
YEAR
04 rA et a, —{.rt > �.;5+�' f r mss.. F:'
.r.- .s'.:.fiafr ',;; =4 t&`y�`.,-,si"s SCE FICATION TATEMENTr
I Me) certivy that on � 1 s day of March, 20_
1 (We) occupied as our principal place of r idence the following described real property for which a Ho Rs 9LVr'ro YhTT )L� giTgPnereby daimed:
:):=A e ❑ re buying under contract
He ficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
.cva'r..k`t•- 3iFa.��i' NTRACT: RECORDED '_`;,`- rr„'_,Y`:`rk
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
P,ROP,ERT,Y. DESCRIPTION_ �' �, �. 34�+.'"">* ��'°!' ��`' LV--, a1' �',d'.e,'. >'?a'�esr�Yi-'? -�,�'r
County
Township
T district (tlry, town, township)
Parcel number
Legal des ription Is the property' question:
—
oeeA Rest property C1 Mobile Homo (I.C. 6- 1.1 -7)
If any portion of the residential structure or the land not oxfoeding on (1) ace that immediately surrounds thairstructure is used to produce income, describe the use and poron
Of the property utilized to produce income. O? ") �y 2 /
()0aV-J 14 : 3- a3- /O/-
cco.96.3 -Cj�6
z`_c3ai� ���''_`- _"^��:?'��?.y` ?"cps P,ROP.ERTYOWNED;BY CL''AIMANT,IN�OTHER'COUNTIES ��� a� it'c��n��f•r.b'ra�� ^u`�.?�Ta
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Sigga�e of claimant
�(
ddress (number and street, city, state, ZIP code)
AT 700 %OF TTV
A�p ASSESSOR USE ONLY f2
b3 TRUE TAXI' -'�
ASSESSED VALUE
r{ HOMESTEAD'`
`x' T zfNON�- RESIDENTIAL .Qj
. '�.'rx?—r. s-.....,.-?w..7 _ ��-
_VAL_UEu, +y
AT 700 %OF TTV
UE
�'aaVALUE.ye,-
Land not exceeding 1 (one) acre immediately
M, O N —N-"'S" "
WE
surrounding residential improvements.
u
Otherland
(2
-.E
Total land (line 1 plus line 2)
(3)
Dwelling
(4)`>r.'s<.>y
'Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
(6)
``..�� avo
' 7r3�5 Vii: r "FSsw -
Other improvements
6
n;z-
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus linen
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 112 Homestead
vauatwn or 535.000
$
Signature of AudHor Date signed