Homestead_RetanaCLAIM FOR HOMESTEAD PROPERTY TAX F� YEAR
CREDIT /STANDARD DEDUCTION
Slate Form 5673 (8817 -07) FIL Prescribed by the Department of Local Government Finance �� JUN
INSTRUCTIONS., See reverse side for filing instructions. 1 6 Z009
1 (We) CERTIFICATION o19SON C@�V1AU jlftp st day of March, 20-
1 (We) oocupied as o rincipal place of resid the following described real property for which a Homestead Property Tax Credit is hereby claimed:
9 1 (We) owned ❑ Are buying under contract
, I 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 ]:eptracL Fee
contract is recorded
number I Page
Counly
PROPERTY
Township
DESCRIPTION
Taxing di ' y, to ship) s
Parcel number
Legal description
$
Is the lin:/
Signature of AudWr
Date signed (month. day, year)
I I property El Mobile l-lome (IC &1.1 "7)
Harry portion of the residential structure or the land not exceeding one (1) are that immedalely surrounds structure is used to produce Income, describe the use and portion
of the property utilized to produce income.
-00-7
ASSESSORLIS
ASSESSED VALUE
HOMESTEAD
NON-RESIDENTIAL
$
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of AudWr
Date signed (month. day, year)
Land not exceeding 1 (cure) acre immediately
surrounding residential improvements.
-
-t -�
Other land
(2)
�i
Total land (line 1 plus line 2)
(3)
Residential improvements aAnnually
Dwelling
(4)
.r • .i- ,ir�.� >�~ c_rs -�.
Assessed Mobile I Manufactured Hone
Garage
(5)
Other improvements
(6)
_
Total improvements (line 4 through Line 6)
(7)
Total value (line 3 plus Gyre 7)
(8)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed (month. day, year)
complete.
Veifying action - Signature of Auditor
Date signed (month, day. year)
STANDARD
_ 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
$
Of 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of AudWr
Date signed (month. day, year)