HomeMy WebLinkAboutHomestead_FranceCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Starts Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUC77ONS: See mverve aida for A&V kn&uctiom
Ki
,FORM YEAR
UHC10
Txr
DEC 1 9 2005
I (We) ceVifto 'IT I;r
M-Istcla OfMarch,20
I (We) occupied as our principal place of Vdente the following described real property for which a Homestead Property Tax Uerleuiyt AINr —
Is JWdatmed:
d
❑ I (We) owned ❑ Are der contract
aHave a beneficial 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.
ZIPMCONTRACT:.RECORDE .7
If buying on contract. Fee Simple owner's name
Reoxcer's of whom contract is recorded Record number Page
K-039! k6P.-ViTY, OWNEEFE3*'C alAaWtl I N16TH EktddiMtSlft ,
-�reWUR �,-
ikOPEkTY,'DUCRfPTIdN fflM� M-11F,
00
Coun
Twmship
dress (number end street, city, state, ZIPCOda) 11 yV
-I
W, j
Taxing district (city, Ir
W9, - T
-V%
Parcel
Legal dO:!q
Land not exceeding I (one) acre immediately
the propeV
question:
-00S
M3 a_? I
Do
Q- Q) q dj
50aI property ❑ Mobile Homo (LC.6-1.1-7)
If any Peru= of the residential structure or the tan, nd, that -trdc®re
of the prop" utilized to produce income-
k used to produce inmme, describe the use and portion
.
(2)
K-039! k6P.-ViTY, OWNEEFE3*'C alAaWtl I N16TH EktddiMtSlft ,
County Township
County Township
I hereby certify the above statements are true, correct and complete.
i ture of claiman
dress (number end street, city, state, ZIPCOda) 11 yV
-I
W, j
. . . . . .
R E' L
V K,,_,!TRfJETAX Rfilk
ASSESSEDNALUE
HUMF5TF-
xt- — -
NON- 'RESIDENTIAL -
Lim
V
VALU ,E
W9, - T
-V%
N-A-yp�!i
,
NO
OR -T-
M
Land not exceeding I (one) acre immediately
�-, .
surrounding residential Improvements.
Otherland
(2)
A 0al- .4 W-- UO`rhio;
Total land (fine I plus line 2)
(3)
'Residential
Dwelling
(4)
Of
t . MOM,
Improvements or Annually
Assessed Mobile Manufactured Home
Garage
(5)
Other improvements
(6)
AP
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed