HomeMy WebLinkAboutHomestead_DailyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (R614-03)
Prescribed by the Department of Loral Government Finance
INS TRNCTIONS- Snn mvnrm coin fiv fifinn ine/n Nlnne
FORM YEAR
C''
JUN 0 5 2006
!?z.t£= CERTIFICA ONSTATEMENTi''_;uvi
I (We) - certify that orYt2e6l 'afy A4V roh, 20 ,
I (We) occupied as our principal place of residence f lowing described real property for which a Homestead BE tTt�(Q.f' NM'(sIIWeb imed:
❑ 1 (We) owned ❑ Are buying under coot t
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.
JNii tl � i< T ti 2 p�
NTRACT 1e rJY iS; 4'1 7,
max- .'RECORDED� e•'�?�s�,rCS{G,�:tT'�' ���"y76�.'- ,�`':�s���sp"�¢
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
_
s3P, ROP. ERT, Y,DESCRIPTION?r'!. �x- "�,r�+is.�,fi,�."r'^>,- ��n-��
County Z6 _
Tonnship
Tai d' tt ��(afyI , to nshi I
/fz
Parcel number
07 - co W v v
Leg despription
Is the property in Question:
Real property ❑ Mobile Home (I.C. 6 -1.1 -7)
H 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.
S' _.'z• -trr [ €'$�y�.1'= _._ .;�. yi.- -.._ ._ .� .- —.- _r. _ - -_ -.-' S air
- - �.x.�^Et �.k�t�vP.ROP.ERTY;OWNED;BY LLAIMANTzIN OTHERCOUNTIES.�s._`' use „,.y%'�`�°�s"i.=�i'f>�;!ts").
County Township
County
Ta hip
I hereby certify the above statements are true, correct and complete.
Signatu dai nt
Address (number and sues(, rdty, s fe, ZIP e)
OD
eV/1LUE,
-� ASSESSOR USE ONLY�ir
1 TRUETAX`f
sVAI:UE
ASSESSED VALUE
�`ATa100
HOMESTEA!-
NON�4ESTDENTUI7
%'OF,�TTVVALUEF
eV/1LUE,
Land not exceeding 1 (one) acre immediately
"" +` + __ "3'?
surrounding residential Improvements.
Other land
(2)
'cN<<:
^
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
4'
(Residential improvements or Annually
Assessed Mobile / Manufecblred Hone
Garage
(5)
r3aXt:�w e-
Other improvements
(6)'”
i 4' i
-
»c
Total improvements (line 4 through line 6)
(7)
Total value (fine 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
20 _ Pay 20 _
Lesser of 112 Homestead
Valuation or 535.000
Signature of Auditor