Homestead_Frederick (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc�o
State Form 5479 (RS 1403)
Pres^.rlbed by the Department of Local Govemme t Fmenoe
INSTRUCTIONS: See reLw= ado for @tp kwLctiiorm
1 (We) 'F s� JL 1 s �P � V YSC r V �� �_ certih} Ihatt on the
7st dasy of March. 20_
y (W occupied as our principal place of residence a following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract O'PG l r6
NHave a beneficial interest in the entity that is liable for the property taxes on the property and that own§Rfie:dropeity «Trs bbO"ig" Ager a contract.
'•; r`. sv.''"_.'' �s.:. i"' x.` Qa'?rk�".�'<CONTRACT'RECORDED's
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
a��,fb'R:`s;���:,.�.yi �?�- v..
a' �1: ��., �>`.. -�:ii?ROFERT,I!�OESCiiIPTION�i' ^?aJ".4.'�z"' �'rd� . ^v.��; 'Yy ^�yyjr�� ^- -• /v {.��
County
Township
Taxing district city, con, township)
Parcel number
Legal on ®
Is the property in question:
4 ^ C
�
eat property ❑ MONO Home ( /.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) a�that' ��ate surrounds that structure is used to produce income, describe the use and portion
of the ptapeny utilized to produce Income. 1�+1^-�
1—iolsE ',��: .PROPERTY,OWNEEFWY CEMMANT;IN OTHER'COUNTIESb` v' t>`` + ," i%°'�`, '+: F`c�, !•!'g.'rfi'€
County
Tovnship
County Township
hereby certify the above statements are We, correct and complete.
.,VALUE'
Signature o
aimant
Address (number and street, city, state, ZIP code)
g 18 N
470600
20 _ Pay 20 _
Lesser of 1t2 Homestead
Vetuabon or 535.000
Signature of Audl n - e 1 I Date s* ned
n e �/ (Q-
'1 Yio_ , K
ES3Eir�NLa
.,VALUE'
ATIEOOEOFaIT!grVALl1E
-,e�� VALU'•i a^
a~px.
"N,
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
-. 7 •�
j"r'4r
Residential Improvements or Annuany
Asttemed Mobile I Manufactured Home
Garage
(5)
-
�C
F' .m
Other improvements
(6)
• €Ye'"','x`}
Total improvements (line 4 through line b)
(7)
Toal value (line 3 plus line 7)
(6)
1 hereby certify the above is We, coved, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1t2 Homestead
Vetuabon or 535.000
Signature of Audl n - e 1 I Date s* ned
n e �/ (Q-
'1 Yio_ , K