HomeMy WebLinkAboutHomestead_SegerCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDITISTANDARD DEDUCTION for
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See naverm aids b)MV %Y6Uctiorsa.
I (We) + r w - 0`J1 r r certify that on the Asvoay�otrnimch, 20
VIII (--- „,W,,�e) occupied as o rincipa place of residence the following described real property for which a Homestead P69M Tta/) itti�h I coed:
(We) owned ❑ Are buying under contract ��N
MHave 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.
CONTRACTRECORDED =7� -3
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
. sr3�¢ 3�: fPROP ,ERTY,OWNEf):BYrCLAIMANIIN, OTHER' COUNTIES ,c'���'?'�,,'���rcr'�{?�cnt';;'
County Township
County
Township
Signature f claimant e
Tadng district (city, fawn, towns hi)
Parcel number
^ b0
Legal description
I
VALUE'
'..- .<.... `�
Is the property in question:
eat properly ❑ Mobile Homo ( /.C. 6-1.1 -7) .
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stmcarre b used to produce income, describe the use and portion
of the property utilized to produce income.
. sr3�¢ 3�: fPROP ,ERTY,OWNEf):BYrCLAIMANIIN, OTHER' COUNTIES ,c'���'?'�,,'���rcr'�{?�cnt';;'
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Signature f claimant e
Address (number arid street, city, state, ZIP code)
'�f'E' �'
ASSESSOR USE ONLY
TRUETAXyy�
ASSESSED VALUE
HOMESTEAD `.
�
” NO E IDENTIAL�
�
'F •. a,S 'iy`�
Mimi. E'<"c
.i' �-�,-
AT�100 %'OF�Tf V
! . �
VALUE'
'..- .<.... `�
r _
-�''. -VALUE
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
1.i' E
Other land
(2)
r, kt
_ ,mg. YU
Total land (line 1 plus line 2)
(3)
Dwelling
(4).,
'Residential Improvements or Annually
fi }-
Assessed Mobile I Manufactured Home
%,area
�UM'`'°`"z-
Other improvements
(6)
-'7' 'r=l
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature ofAmditor
Date signed
20_Pay 20_
Lesser of V2 Homestead
valuarow or 535.000
Signature