HomeMy WebLinkAboutHomestead_Beck11
CLAIM FOR HOMESTEAD PROPERTY TAX SC FORM YEAR
CREDWSTANDARD DEDUCTION Hcto
Sete Form 5173 (R6I4 -W)
Prescribed by the Department of Loral Governmem Finance
INSTRUCTIONS: See reverce adds br lift irffiucuyrs.
I (We) �V�/ ►''� -[ 7`^c.(Li rwi1 �f� ceiilfy 6iaF orr'U 3tuday of March, 20
I (We) opted as our principal place of residence the following descn ed real properly for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contracts
Have a beneficial interest in the entity that is liable for the property taxes on the property and that ��a pUG eOpryis!b der a contract.
3CONTRACTtRECOR_ DEOv�s, �?ia'"' f.' �` Sr? n• 3�?�;^: ,3j1`,�s,�t�a,.;•.�1��„�"�,,"'�
If buying on contract, Fee Simple owner's name
Recorders office where contract is recorded Record number Page
�`°a�:'�����FROPERTY,�OWNEDrBY CLAIMANT IN'; OTHER` COUNTIES, c�-' �- �t�f?rji
'ligg-aT-'��#t3 4P,ROPERT.Y,OESCRIPTION 1MRy-3 _"
County
Township
Township
Taring dis ('ry, tp
r
ber O
O 0,0
aI criptiop
Is the property in ques'
* �TRUETAX�
SS D'VALUEHOIdESTEADi
pr My ❑ Mobile Home (I.C. 6 f. 1-7)
left any dion of the residential structure or the land of exceeding one ( a
e IheI immediately surrounds that structure is used to produce income, describe the use and portion
produce income.
. t" i„ A, T700% OF,
V� 7�-
'...`.VALUE"y'rytc�.�,'�t
�G CX. 41po�- c�
(1)�
�`°a�:'�����FROPERTY,�OWNEDrBY CLAIMANT IN'; OTHER` COUNTIES, c�-' �- �t�f?rji
#,Is- �e�"'�.!^`�a`.'?�k�'
County Township
County
Township
hereby certify the above statements are true, correct and complete. Si tore of claim nt
dress ben ands city, slate, ZIP code
4 �o�
'�� r
`x;R - 3ASSESSOR!USE ONLY
* �TRUETAX�
SS D'VALUEHOIdESTEADi
r N RESIDENTIAL M)k
=�w'
yq_L_UEyb',y,
. t" i„ A, T700% OF,
VALUEb
'...`.VALUE"y'rytc�.�,'�t
Land not exceeding 1 (one) acre immediately
(1)�
U—MR � °,DWI II
surrounding residential Improvements.
Other land
(2)
M y, . `i5 t?',z
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)
yt'"M s
'Residential improvements or Annually''''"
Assessed Mobile I ManuleMired Hama
Garage
(5)
Other improvements
(6)
Total improvements (line 4 through fine 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed