Homestead_KnollCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION C1
`
Site Farm 5673 (Re 17.07)
Prescribed by the Departme rtmed of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) Si V 3Ci 1 \ iin Y certify that o�', t.tla�0larch, 20-
1 (We) occupied as our principal place of residence the following described real property for which a Homestead Property T i 40@95aimed:
W(We) owned ❑ Me buying under contract GIBSO C
e 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.
CONTRACT • -r
If burying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
PROPERTY OWNED BY
County Tmmship
PROPERTY
County
Township Taxin ist (city own townshi
Parcel number
L al description
n rt Is the props n:
TRUE TAX VALUE
ASS E�S`EDMALUEJ
JLJCD ❑ property ❑ M e (IC 6-IJ -7)
I
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that strucilure is used to produce income, describe the use and portion
of the property utilized to pmduce income.
a to -19- ►`:� - io I -co (. «� -c�7
PROPERTY OWNED BY
County Tmmship
County Township
I hereby certify the above statements are We, correct and complete.
Sr daimam OV
s(numberandstrest, city state, and ZIPcode)
,^, �✓/
C_.l_ tom( Ll/L2ci
ASSESSOR USE ONLY
TRUE TAX VALUE
ASS E�S`EDMALUEJ
HOMESTEAD NON-RESIDENTIAL
AT 100% OF TTV
VALUE VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
3;
Other land
(p)
Total land (line 1 plus line 2)
(3)
Dwelling
(q):�.:
Residential improvements or Annually
L
Assessed Mobile I Manufactured Home
Garage
(5)
Other improvements
(6)
Total improvements (fine 4 through line 6)
(T)
Taal value (line 3 plus fine 7)
(8)
I hereby certify the above is true, cared, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature dALdtor
Date signed (mmfh, day, year)
STANDARD DEDUCTION
Pay 20 — 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
Lesser of 12 44,000 for 2008
Homestead Valuation pay 2009 41,000 for 2011 pay 2012
$
a 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor
Date signed (month, day, yW
AN