Homestead_Conawayryn g CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Forth 5473 (R418 -00)
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INSTRUCTIONS: See reverse side for filing instructions.
1t, 'SO D M
DEC 21 2001
I (We) lJf// 1L.QarEfyTh`dPtSnW 1st day of March, 20_
I (We) occupied as our principal place of residence the following d bed real property for a Homestead Property Tat Credit is hereby claimed:
,*(We) owned El Are buying under contract
lave 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-
'>�3?1 CONTRA' o ECORDEU
If buying on contract, Fee Simple owners name
co
Rerders office where contract is recorded Record. number Page -
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' r y PROPERTY= OWNF�)BY CLAIMA'—
----- .: f���R??�PRO_ P, ERTY�DESCRIP, zTIO_�xi�;ty.- `�-c�$��,.�_Y.'a9 • _�,
County
Township Taxing district (city, town, township)
Parcel
ber
Legal description
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+
i Lu
Land not exceeding 1 (one) arre immediately
(1)rt`r"5'
It any portion of the residential structure a the land not exceeding one (1) acre that t surt unds that s e is used to pmduce income, describe the use and portion mmcr
of the property utilized to produce income. - - - -
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' r y PROPERTY= OWNF�)BY CLAIMA'—
r-�� V -
County _ - Township -
County Township
I hereby certify the above statements are true, correct and complete.
Signature of claimant
"ress (numberand street, city, state. ZIP code)
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°ffi- ��ASSESSOR USEONLYa
TRUE;TAX
ASSESSE VDd' A, LUE
r,HOMESTFIID�'
�" ' NON - RESIDENTIAL. -
_ i
�MZT1U-
_
m- ^n�U�i<?4...�
+
.s,.. Y VALUE.��,...,
Land not exceeding 1 (one) arre immediately
(1)rt`r"5'
surrounding residential improvements.
NF 51t
Other land
(2)
s3
Nf=�
Total land (fine 1 plus line 2)
(3)
Dwelling
(4)=-
° .
x �_ 1-
Residential improvements
c 6 ;^_'a'.Nze --
Garage
(5)`il"''-
--,;
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature ofAssessor
Date signed
complete.
Verifying action - Signature of Auditor
0
Date signed
n _µ ffl �r; �+ r�r. STANDARD`.I)EDUCTIONAL'LrOWANCEFF,�
20 _ Pay 20
Lesser of 12 Homestead
$
Valuation or $6,000
Signature of Auditor
Date "
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