HomeMy WebLinkAboutHomestead_BaneCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
Stets Form 6173 (R614-03)
Prescribed by the Department of Local Government Finaoce
INSTRUCTIONS: See nsverea aids Ibr 1St iutructionit
I (We) /� tv lti ► r 1 Q. ELI. _tom
I (We) occupied as ou+principa�iace of residence the foilpaing described real property for
F1 1 ed 1-1 v
FORM "I I YEAR
HC10
that " e t d of March, 20
a(op J re is hereby claimed:
(We) own Are buying under contract 0 C j 2 04 ((��((��tt _
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propeliY13 buying under a contract.
If buying on contract, Fee Simple owners name
where contract is recorded
Record number I Page
PROP,ERTY;DESCRIPT1ONt&j"�3`� Vx,,...�.>- w�;..+x��,
County
Township
Testing district (city,. town, township)
P I
dare number arxi sVeet, city, sta e, ZlP code)
o
ep 30
Is
he property in question:
❑ Real property ❑ Mobile Homo (LC. 6-1.1 -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 ulil¢ed to produce income.
R- PROPERTY,OWNED'::BY CLAIMANT,IN;OTHER'COUNTIES .ar' ✓ +a m.Si 3 f '" ' F !^;7- '+�". -• 9`"
County Township
County Township
I hereby ceAi the above statements are true, correct and complete.
i ure claimant
dare number arxi sVeet, city, sta e, ZlP code)
o
�� 'ASSESSOR USE ONLYA.
a'.�- °.3}`. . �.,,_ anyg.g.g44?�S�%r%.- 37'��5���aut
''TRUE TAX ��ix
�.VALUE�:a:�
ASSESSEDVALUE
xATa100%'OF�'TTY•�
HOMESTEAD .cam
�VALUE�
yNONNtESIDENTIAI�'}��•
:o-l';:?`�VALUE:
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
,,
Total land (line 1 plus line 2)
(3)
Residential improvements or AnnuaOy�'
Aaseased Mobile I Manufactured Home
Dwelling
Garage
(4)
(5)
1...,;< 4�
Other improvements
6
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is true, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20_Pay 20_
Lesser of 112 Homestead
Vauatlon or 535.000
Signature of Auditor