Homestead_Stilwell (2)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION HCtO
Slate Form 5.473 (R6140.3)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for tiling instructions.
I (We) ceuddry� at o tt/n�y11�s, day of March, 20
(We) oco p' as our principal place of residence the following described real property for which a Homestead Proper y Tae C edit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and
a contract.
ONTRACTRECORDED'
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
': y- t''$_:`#._"`^.- es:° i- ?gv' t.-' t^.-, 3��`.. P, ROPERTY.DESCRIP,TIONe?F�tF.�.,.
Count'
Township
Taring district (city, fawn, fownshi
DMpaj
Legal Legal description
Is the property in uestion:
lumber
k/( /Ito
Real property ❑ Mobile Home (LC. 6-1.1 -7)
N any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income.
KM' —V CL'AIMANTtIN;OTHER'COUNTIES ��.
County
Tavnship
County Township
I hereby certify the above statements are true, correct and complete.
Signal a of Claimant
Addres (n m ran treat, ri (gate, ZI codeya
Signature of Auditor
, i'4TRUE
vAS$ESSOR USE ON Y :X<
TAX> :'ASSESSED
' i.
VALUE
t FiOMESTEADy``
P
�;`NON�RESIDENTIAL
'Sr `nVALUE`z-
::.... sss..!L...
+FVALUEyi'�
, +,s•., ..x_
AT 100Ye OFTTV
TWA
VALUE!'
`�, vi7P�
:
ri_:aliI .mss
Land not exceeding 1 (one) acre immediately
-nee
surrounding residential improvements.
Other land
awn
Total land (line 1 plus line 2)
(3)
Dwelling
gq
".vy
(4)
�KS to
Residential improvements or Annually
Assessed Mobile I Manufactured Home
Garage
5)
s `
.ay<;Ss
�"
Oilier improvements
(6)
� -.. � '1Fk
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
I hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
{ fiSfu1- �,= ".#-'..,' —��; STANDARD`. DEDUCTION 'ALL'OWANCE,.;°?;,,w`pa{`,
20 Pay 20
_
Lesser of 12 Homestead
Valuation or E35.000
S
Signature of Auditor
Date si n
O