HomeMy WebLinkAboutHomestead_Clark (2)ly, �
CLAIM FOR HOMESTEAD PROPERTY TAX L
CREDIT /STANDARD DEDUCTION I 10 L
State Fern 5473 (R715�
prescribed by the Department at Leol Government Finance
INSTRUC77ONS.* See reverse side for Ming instructions. AUG 2 8 Z007
I(we) i r-c?— ., (✓ I/ ICZ/ — certifxiu ®s®rUt6QSta�yt a% aicl;, 20_
I (We) occupied as our prindpal place of residence the following described real property for which a Homestead Property Tim Credit is hereby claimed:
D I (We) owned ❑ Are buying under contract
IHave 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.
C ONTRACT, , J).
If buying an contract. Fee Swoo owners name.
Peowdees, Wfim Were carMwA m recanted Pecard number Page
% iO.�,k ,, s ,I';:`]: +PROPERT.YOVMED BY. CLAIUMT[N.OTHERCOtarlmsf
County
PROPERTY DESCMPTIOW?�,'
County
ToWnstap
I hereby car* the above statements are true, correct and complete.
Tsang district (cily. �. townsfuip)
'77 o> LIJ
W 7/7 '(71 7r,-
A I
-T A) 640
1 4gal �
Parcel number
Leodesciptian
suarounding m--AenW improvements-
Is the property in que#&:
�'
I ❑ Realm-party ElMobile H. (LC. &1.1-7)
If 4M portion of the resideritial sbuclure or the land nal e&a9ding
one (1) scre that inrtedWely surrounds Mal sbucture is used to produce name, I deambe the use arid portion
CT properly utilhad to produce name.
-/9- V03- 00/
ol- 9'3 -oo -2
% iO.�,k ,, s ,I';:`]: +PROPERT.YOVMED BY. CLAIUMT[N.OTHERCOtarlmsf
County
Township
County
7owrahip
I hereby car* the above statements are true, correct and complete.
Signaftue al
X
'77 o> LIJ
W 7/7 '(71 7r,-
A I
-T A) 640
il'
ASSESSOR USE ONLY
fITRUEJAX,
'r
ASSESSED VALUE
�IATAOWOF
�HOJIIIESTEAD.,
il��
NC
y
VALUE �
Land not exceeding I (one) acre inntnediately
suarounding m--AenW improvements-
Other Land
(2)
"Idled land (line I pka Eno 2)
(3)
Dwelng
(4)
RvMa
Residential rnproernents o Anmially
Garage
(5)
.q, .r v v 4m < �
Assessed Mobile I Manuffaclured Home
Other improvements
(6)
Tdal p4mrvements (fine 4 through Eno 6)
(7)
Total value (line 3 pke fine 7)
(8)
1 hereby certify the above is true, correct. and
complete.
Sqnsture alfAssesser
Date sigried
%kn" ac0on - signature of Auchar
Data agreed
Z
:1,",P".W.i:"S7ANDAFtD DEDUCTION ALLOVIAXCE-i!,.yZlci, �.
'z
20_ Pay 2O_
Lesser of 112 Homestead
Valuation or 135.000
Squmxe of Auditor Date signed