HomeMy WebLinkAboutHomestead_HaleyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State From, 5473 (RT I5-M
Prescribed by the Deomtreent of Loral GovermraA Fn
INSTRUCTIONS: See reverse side for filing instructions.
F_ FORM L�
HC10
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• -:. �. ., , .,,. .: ...; C82TffTCAT1ON STAIEYENT. "- f. "5, " �:ji:a ,*":.•
e) a, L e �/ %� Iq / 5 f/ certiy that on the 1 st day of March, 20_
1 (We) occupied as our principal place of residence the following described real properly for which a Homestead Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
❑ Have a beneficial interest in the entity that is liable for the property taxes m the properly and that owns the property or is buying under a contract
CONTRACTtRECORDED.r(.?/- `y+'S'Nf:!Y7 ?:,,:r$!
.., -.
If buy'og m ..b'aLt Fee Sihroe ownefs name - .. .
Facordefs office where cor4ract is recorded Reaxrd number Page
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`� PROPERTY DESCRIPTION >. , ,. LH. . a ✓r '.. .-, ,.. n... j.rrf.v �..: }.. YArh ,.f,�t.
Canty "h•5
Towrsfhip
... s ".:.t
.Tang district (aiy, fawn, fowmsfdp)
iAT 1007LrOETTY „dS:',.�VALIIE.r,i..•r.7,ta
VAppLUE
Parcel number
Legal descriptim .
..
rQ
Is the properly n question:
- a oa :- y:o -,v;
a U • .�%
i 3 -a
❑ Reel ❑ Mobile Home 6.1.1
-�
p .
r.Z
_r.:o c; prrperty (LC. -7
tarry portion of the residential atnhibve cr the lark! nul wieI
one (1) acre Ihet ininedeeely wrrauhCs Iral'strhirtae is used to pmdce Immrre, describe the use and padim
of the property ugf®d m prodweehcnne. -1 :!;, ^,:.
r, ,.., ,,. ^a,,:- 1s:.,'� k�... t:nfl bng r. v. ,.
Township I County
I herebry oer* the above sfatemerrts are true, caudal complete:_ ife °f.`�"",8f°n L •'., . .:
.. f i tfl-:, n zJdo r. -
A&hess (member and Street city fie, ZIP code)
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ONLY
s"f TWE TAX
ASSESSED VALUE
P HOII�STEAD`'
yr„ ' NON4tFSIDENTiALCr"• a>
Lesser of 12 Homestead
iAT 1007LrOETTY „dS:',.�VALIIE.r,i..•r.7,ta
VAppLUE
Land not exceeding f ( one ) ace immediately
(1)
,!'urns. ^: t,m
r.n :r,._
'` k; 'a(Ar F�• F� d YR� i
surrounding residential improvements.
)ate >
Other land
(2)
: !, c o- - _ '.t r-;
1-i
Tdal land (I= 1 pha [no 2)
(3)
Dwelling.
(4) _
r' , ..
Residential Improvements or Annually
Garage
- �U'�Etl �lt•r Arr� ft '' 1 *
Assessed Mobile I Manufactured Home
5
_ _
�t.rs
Oder improvements
(6)
Try Improvements (!are 4 through fine 6)
(T)
Tdaf value (Ibe 3 pus fine 7)
(g)
I hereby certify the above is true, correct, and
Signature of AsamIa r
Dade signed
action - Signature of Audtar
Dade ail;
STANDARD DEDUCTION ALLOWANCE
, r ' 'r� - • '
20_Pay2O_
Lesser of 12 Homestead
$
Valuation or M,000
Signature of Audtor
)ate >