HomeMy WebLinkAboutHomestead_Whitehead (4)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION Hc�o
State Forth 5473 (R6 / 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for riling instructions.
FT
.ERTIFIC TION STATEMENT" QQ.
I (We) f ,(� p6of March, 20
(We) occupied as our p0cipal place of residence the f owing described rea03roperty for which a Homestead Property Tax Credit is hereby claimed:
❑ l(We)owned ❑ Are buying under contract -?716
8 rQ
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns lCh'Iep?rr��4tlyip¢.IgrPa contract.
s eown ,CONTRACT?RECORDEDS!,?,"'.c�,l
-
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
n'�u�- tai' 4-` P,ROP.ERT.Y:DESCRIPTIbN`-_"`. ` ?r'. t�,: 3, ce!` a`,- "'+,-- '�- a,n,.�.4r'r'''�,sfSir-
County
Town
Taring district (city, town, township)
P mbor
I � U)
Le I crip6 R
E V
Is the property in question:
❑ Real property ❑ MONO Homo (l.C. 6f.1 -7)
If 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.
nx".3'.e- .�`W' --` "+�+ t. Z ? "Y PROP.ERTYAWNED`'BY CLAIMANT!IN'OTHER`COUNTIES
.�"4r °.�: r;} 4 ,.`.'+ysX" -. "�O"`,xra`'N
County
Tavnship
County Tavnship
I hereby certify the above statements are true, correct and complete.
Si at re
claimant
OW
.Address (number and s
' -iry stpte, ZlP e) Lr� r
Land not exceeding 1 (one) acre immediately
+' ASSESSOR USE ONLY ;' 7c
TRUE TAh>:
ASSESSED VALUE
" HOMESTEADb
X4 NON=RESIDENTIAL
s,
T�100 /o'OF`TTVVALUE
y�`VALUE -i+�
Land not exceeding 1 (one) acre immediately
1
surrounding residential improvements.
Other land
2
Total land (line 1 plus line 2)
(3)
Dwelling
(4 )`
}}.jS{rr�'-'SSjj 44vv
a
(Residential improvements or Annually
"'-�+^�'
Assessed Mobile / Manufactured Home
Gara a
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
Signature of Assessor
Data signed
complete.
Verifying action - Signature of Auditor
Datesigned
20 _ Pay 20
Lesser of 112 Homestead
Valuation or 535.000