HomeMy WebLinkAboutHomestead_Lee (4)} CLAIM FOR HOMESTEAD PROPERTY TAX Od M
YEAR
CREDIT /STANDARD DEDUCTION H¢nDJ
State Form 5473 (Res / 1-03)
Prescribed by the Department of Local Government Finance OCT 17 2003
1 (We) //G f__ [/ 11—M 14 certify that on the 1st day of March, 20_
1 (We) occupied as our priAcipal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed
❑ I (We) owned ❑ Are buying under contract
rh 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.
acesi`err
+CONTRACTRECORDEDi�t"'
If buying on contract. Fee Simple owners name F
Recorders office where contract is recorded Record number Page
20 Pay 20
iser t2 Homestead g
Signature of AUddw , Iua lone% /7'0
, s PROPERTY; OESCRIP. TION.'- �tS' aa.: 7-°` :a°�,"rjTa"-I,.'`?i`+56'vu ""'-' in
County !
Tam
Testing dill (city, township
4_1AC,
Address (number and street, ("W119 ate, ZIP code)
k.�. y�'66a— y3o�
r A
e
Parcel qtr ber
L al de cripGon Is the property in question:
��1
D I rt 0 - V
- / 9 �eal property ❑ Mobile Home (I.C. &1.1 -7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income. fq
20 Pay 20
iser t2 Homestead g
Signature of AUddw , Iua lone% /7'0
County Toanship
County Toanship
hereby certify the above statements are true, correct and complete.
Signatur of claimant q
Address (number and street, ("W119 ate, ZIP code)
k.�. y�'66a— y3o�
sq` '
< ASSESSOR�USE ONLY �x
3-� 'ST7.aL1`?i�T'3�t:e4iai'�+: 1 :3
TRUEeTAX
�.La ... ;x.�
ASSESSED.VALUE
'."AT3700 %'OFTTV
� y.rn.... -sal
HOMESTEAD -
VALUE'rs�
-. .�.N.�4
'"NON- RESIDENTIAL r
' VALUE zk�-
W1.- ir}:'s..: .,isY..�SS
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Residential Improvements or Annually
Assessed Mobile / Manufactured Hone
Dwelling
Garage
(4)
(5)
:L (; Yin JSj
z= e d � '•
` " Mal
'r.
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (fine 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Data signed
20 Pay 20
iser t2 Homestead g
Signature of AUddw , Iua lone% /7'0