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I CLAIM FOR HOMESTEAD PROPERTYJAX
CREDIT/STANDARD DEDUCTION
V Suite Form 5473 (R614-03)
Prescribed by the Department of Local Government Fir;aiice
INSTRUCTIONS: See reverse side for filing inshirriono;
=
YEAR
APR 2 5 2005
I (We) \,,_�JLLOA�� I r I V _)i tk1L L G V_) - owleubfw-
pe for wtQ�y Tax Credit is hereby claimed
I (4,Ve) occupied as our principal place of residence the following described real pro Iii oM tea"d Propert,'N""t
DI/\<1) owned ❑ Are buying under contract
Have 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.
If buying on contract. Fee Simple owners name
Recurder's office where contract is recorded Rewrd number Page
PROPERTY DESCRIPTION
County Tovnship Taing distwl (city, town. township)
Parcel number Legal descriptinn Is the Property in question:
C❑ Rest property ❑ Mobile H. (LC.
If my portion c! the residential sh� - �ow the 3 id not exceeding one (1) acre that immediawIV sumunds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
-co -7
-ASSESSOR USE'ONLY2�i' 1. ' — - -
County
Township
County Township
I hereby certify the above statements are true, correct and complete.
S t of clain, t
- 5 1dress (number and street, city. state, ZIP coda)
-ASSESSOR USE'ONLY2�i' 1. ' — - -
TRU E-TAX
ASSESSED VALUE
:4+HOMESTEAD
'NOWRESIDENTIAL
M2
VALUE
--AT 100%'OF 'TTV�
's�.VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
n
Otherland
(2)
-1!--
D:
Total land (line I plus line 2)
(3)
Dwelling
(4)
ZPr
j
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage,
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(7)
71
Total value (line 3 plus tine 7),
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed
STANDARD DEDUCTION ALLOWANCE
20 _ Pay 20
Lesser of 112 Homestead
Vauation or 535.000
Signature of Auditor
Date signed