HomeMy WebLinkAboutHomestead_Kerney (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
StMe Foan 5473 (R7 I 5-W
Prescribed by the Depannord of Local Goverrvnerd France
INSTRUCTIONS: See reverse side for Mina instructions.
Ir
a
BREN-221
I If
UOUNTY A-
I (We) LQ-�� C <Z\ that on the I st day d1' 20
I (We) occupied as our principal-p&m of residence the ly" descnbad real property for which bead Property Tax Credit is hereby dairned:
(We) owned ❑ Are buyg under contract
Have a beneficial interest in the entity that is liable for the property taxes On the property and &at owns the property or is buying under a contract
k X C0Pn1RACTREC0FtDEWj!,!
If hiying m ma Fee Single owner's name
Recorder's &km where =r*W a recorded Record number Page
M OWN631( CL AbLAN TIN.VMM CDUNiffS- Z�
County
PROPERTY bEsouprnoW
-11t
� - 1� - A.
County
TuNnship
claurt
TmmV district (
. c1to
V'P ()o afd
Parcel nurnber
Leo description
the
-
n., � - r�
If.
Mob Harris (LC. &1. 1-7)
If any portion Of the residenfial sbucture or the tand nol comeeding are (1) acre that irnnaclately nmar.nds tlrA atrumxe is ua,3d b pro A m mcorre, cleambe the ume and portion
of the poperly Wkmd to pmduce oorm-
'h'
Other land
(2)
M OWN631( CL AbLAN TIN.VMM CDUNiffS- Z�
County
Township
County
Township
I hereby oeftffy the above statements are hue, correct and complete.
claurt
87 Number and. street. uityns7 ZIP )�
e/WA,
V'P ()o afd
I V
t�,STMDAMDMUCTMALLOWANCE i'-
TWE TAX
ASSESSED VALUE
HOLW-S,TE-A-0"
--l"NONAESMENTIALtUR
ASSESSOR USE ONLY - "'� I *�
- , , *
00%,OF TTY -
c�v,'.,VALUE
in:~.':.. I I
Land not exceeding I (one) acre irrynediately
Valuation or $35,000
surrounding residential unproverments.
Date spied
'h'
Other land
(2)
Tctal land (Zirm 1PAvs Ene 2)
(3)
0-1
401
Dwel1ling
(4)
NR NA, 't, - 'm
50,
Residential irnprom.ientsorAnmLally
Assessed Mobile I ktuxrfixtured V4m
Garage
SN'
(5)
"unprovertnenfs
Other
(6)
Tdal irnprovernerds (line 4 through One 6)
(T)
Tctal value (line 3 Plus Am 7)
(8)
1 hereby certify thealm" a hue, correct, and
cornpiete.
signature of Assessor
Date SONd
%ft*PV acdm - Surat" of xxttor
mra signed
t�,STMDAMDMUCTMALLOWANCE i'-
mr 20 Pay 20
Lesser of 12 Homestead
Valuation or $35,000
Date spied
6-1