HomeMy WebLinkAboutHomestead_Culbertson (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDMSTANDARD DEDUCTION
State Foon 5473 (R7 I 5A11)
Prescribed by the Department of Local Govemmeit Fiance
INSTRUCTIONS: See reverse side for Ring instructions.
JUN 1 9 2007
certify that on the 1 8�wroqriqw-
I (We) occupied as P=# of ;�� thetgowing described real property for which a Homestead PmqQqwN L t
it is hereby daimed:
EPXM) owned ❑ Are buying under contract
(Wave 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
I as a�
c,CONTRACMIRECORDEX KK
It hilring on contract. Fee Simple ownees name
RODDirdWs office where contract is recorded Record number Page
WUW'i&qW' Q PROPERnf omEi3FBYcCkmANT.m'oTHER'couKnEsiga'F(ev.,V-P,-:',.rsk4wn�46'+�.-,srtiro
County
Township
TwJng district (cly. town, townsttijo)
Parcel nurnbar
L=
the in - :
AddressOwnberandsheet 'K
ddress i
0 V ). cily. kt-INA"
&14.1
/g=pWortY Mobile Horr,s (W. 61.1-7)
n
m arty Portion of the residenlial structure or the land not exceeding one (1) eate thatirl'ineclately surrounds thd olicture is used to Produce income, describe the use and Portion
d the Property ugr®d to Produce incxsne.
30y-000. 75'-/ -GO 7
WUW'i&qW' Q PROPERnf omEi3FBYcCkmANT.m'oTHER'couKnEsiga'F(ev.,V-P,-:',.rsk4wn�46'+�.-,srtiro
County Township
County Township
I hereby certify the above statements are true. correct and complete.
NO W ESIDENTIAL "WIN'
,R
Lesser of 12 Homestead
AddressOwnberandsheet 'K
ddress i
0 V ). cily. kt-INA"
"
I 7 66K
K
qW U
HOW "
STER
NO W ESIDENTIAL "WIN'
,R
Lesser of 12 Homestead
Valuation or MODO
Q"�
Signature of Audftx
Land not exceeding I (one) acre immediately
0!10
surrounicling residential improvements.
(1)
�ffln
Other land
(2)
Toted land (line I plus Aare 2)
(3)
rm
Residential improvements or Annually
Dwefiirg
(4)
Assessed Mobile I Manulacturnd Flocne
Garage
(5)
Other improvements
(6)
Total improvements (Aare 4 through fine 6)
Total value (Ibe 3 phis fine 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signalure of Auditor
Date signed
20 _ Pay 20
Lesser of 12 Homestead
Valuation or MODO
Signature of Audftx
Data signed