HomeMy WebLinkAboutHomestead_WilkinsonCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Forth 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUC77ONS: See reverse side for riling instructions.
FORM � YEAR
HG
W- i`E�`�asol} STATEMENT'-:. P
MAP 9
, -
I (We) Anp certifq'thatmn la/jitday of March, 20
(We) occupied as our principal place of residence the following described real property for which a Homes P,rooe�riv xc f:redit is hereby claimed:
❑ l(We)owned ❑ Are buying under contract1 `� VuNT� AUDITOR y
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.
Vt-' '.. s.#- sxi'' Fi' f=>."' r' i- ii'.CONTRl1CTRECORDED?':=`�L.ta - �- :6r...N�..3``a- 'i'SrS. t•:c'�r'.a,.,..:'*
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
ROP,ERT,Y.DESCRIPTION �:' ,+ -k. -' r;s'. yY; ' z �,s�. -g
--/: �•�Cx'i....k�x..v.h.— .s'a.^7 .. <r;:Y1S�:.- iF�t�.r —.1 �-
County
Tmnship
Taring distri ( y, to wnship)
Parcel number
- ' /0
Legal description
1 1 r7 Q-
s the prope i uestion:
property ❑ Mobile Homo (LC. 6-1.1 -7)
H any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds t t structure is used to produce income, describe the use and portion
of the property utilized to produce income.
a�'�3kc�.- .moo",: -: �• �PROP.ERTY;OWNED!BY CL'AIMANT.IN.OTFIER'COUIJTIES
t,.`''„p'`.�.:-
�'i5y�^�,.�.
County Township
County
Township
hereby certify the above statements are true, correct and complete.
Si re of cla' ! ' A
�GCr
•ldre (rupmbe and sir let, d= s , ZI
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v`
R'- .C�t"2:s!.'L x.. ,+'W
�' "uSSESSOR USE ONLY f= ��'
'[''
yk
, s TRUE TAXI
_
ASSESSED VALUE
�i.vva
HOMESTEA
fVALUEs
✓�' %K+ -
.NON= RESIDENTIAL -"1
"}t'st..'VALUE-*
.LLpT W��.y - �• {'�yq
z VALUES` C
xd ." _
AT 700 %OF'TTVy.
.N.a. I
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Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
G�g>rr T
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(q)
Residential improvements or Annually
n?r< 02.
� `
Assessed Motile / Manufactured Home
Garage
5
()
A
Other improvements
(6)
s
y�,��[�,�''
`S:cu`
—1
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
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
,; 5.: �a, 4 ,,,•,- �"?':,>STANDARD.DEDUCTION ALLOWANCE i- •_el7 t�
�.�. :•ate ;ham �
20 _ Pay 20
Lesser of 1r2 Homestead
Valuation or 535.000 S
Signature of Auddw - Date signed