Homestead_Church (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HCto
i i
State Fond y the D6 artme �q g � _
Prescribed by the Department of Local Government Finance J[)U {,l�q,. � [Ljgl `j'g�
INSTRUCTIONS: See reverse side for filing instnrcfions.
:: +;z- _'",, NW;� �3.. �=tCERTIFICATION STATEMENTu ,st.i ��ycs#e . ._ a�'sj,,! -'
(We) ___ .. - fr certify that ^thV 5l day o�Sih. 20_
1 (We) occupied as our princip lace of residence the following described real property for which a Her" PropertyTex Credit is,hereby claimed:
I (We) owned ❑ buying under contract
GIBSON
Have a It 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.
If buying on contract, Fee Supple owners name
Recorder's office where contract is recorded Record number Page
^�?ROPERT/ OW1JE6 -8Y,* LAIMANTAN OTHER`CUUtJTIES'±��:��
County
PRO P, ERTYDESCR )P.TIONpe #4wti?,-•�ra�,
",'r.
Counh
Toxnship
Add r ss (number and street, city, state, ZIP code)
Taxing ' t (ctt , to , township)
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ASSESSOR USE ONLY-
`�«tyF:!r�VALUE�AATF100
'TRUETAX
ASBESSED'VALUE
zr , ,
�+
HOMESTEAO.F
t' NON- RESIDENTIAL h
err Wnper D/ /- �O
�C /O
Le al description
n (� n
Is the pro p6 u"bon:
VALUE4 ssr.
Land not exceeding 1 (one) acre immediately
raO /ere
Real propeM
❑ Mobile Home (LC. 6-r'. 1 -7)
If portion of the residential structure w the land not zceeding one (1) that i media(((eeety surrounds that swcture is used to produce income, describe Na use and portion
of the property utilized to produce income.
a3 / ,
^�?ROPERT/ OW1JE6 -8Y,* LAIMANTAN OTHER`CUUtJTIES'±��:��
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
Si ture ima
Add r ss (number and street, city, state, ZIP code)
12 3 S. 9 r Al klq PIP Q �j
-s ri'c
ASSESSOR USE ONLY-
`�«tyF:!r�VALUE�AATF100
'TRUETAX
ASBESSED'VALUE
zr , ,
�+
HOMESTEAO.F
t' NON- RESIDENTIAL h
/eOaT1Y�VALUE�.-
VALUE4 ssr.
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
tl
Other land
()
MKT—E i
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
t r
Residential Improvements or Annually
Assessed Mobile I Manufactured Horne
Garage
ge
(5)
."' =�'h: k �"
Other improvements
(6)
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line n
(6)
1 hereby certify the above is We, coned, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Date signed