HomeMy WebLinkAboutHomestead_DameCLAIM FOR HOMESTEAD PROPERTY TAX FORM YFAR
CREDIT /STANDARD DEDUCTION
Starts Forin 5473 (R71 5-06) 1�2
Prescribed by the Department of Local Coverrvnerd Fmnca
INSTRUCTIONS: See reverse side for (ding instructions.
I (we) 71, A k 11,1114ze--j _ certify that on the W day of March, 20_
1 (We) occupied as our principal piece of residence the following described real property for which a Homestead Property Tat Credit is hereby claimed:
&(We)owned ❑ Are buying under contract
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
CONTRACTRECORDW�'q,,A�
ff buying on contrack Fee Simple owners name,
Rom ens OfEW where contact is recorded Record number Page
—PROP, ERT.Y,0ESCPJP-TlO
County Township
Comb
'p
7
I
dist ir (Cd'y tDWl'i, township)
Pa
L692J description
is the property in o6kion-
Land not exceeding 1 (one) acre immediat*
0 Red Wprry ❑ Mobil. He. (LC. &1. 1-7)
Harty portion of the residential structure or the tend not exceeding one (1) acre that romeikatety wirounds that structire is used to produce income, describe the use mid portion
of Ne property utilhad to produce income.
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surrounding residential improvements.
PROPBUXOWNED-BYXLWMANTfN OTHER COWMESW�,WIW- 'P6,1q,
County Township
County Township
I hereby certify the above statements are true, correct and complete.
Z of dainnant
� =='
Or(number and sirset crlY slate, ZJPcode)
P F 4Z /)cLi A I, e,,, I R A. /-4 am 6 h -!r IV 4-1 7K Ly( n
M STANDARD'DEDUCTIONIALLCYWANr-E,�,W OMS'x,W�,g�Oft "W
20_ Pay 2O_ I
Lesser of 12 Homestead
Valuation or S35,000
Signskire Of Auditor Date signed
"�m'TRUETTAX;A' ,'
'2
--- -- ------ ------- --
ASSESSEDYALUE
.? M NON 41ESIDENT14L,
E;V��
O�T -TT
Rti- tv"i
Land not exceeding 1 (one) acre immediat*
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surrounding residential improvements.
Other land
(2)
��1;®r'
Tctef land (firie I plus rme 2)
(3)
improvements
Dwelling
(4)
Residential or Annually
521-
Garage
(5)
Assessed Mobile Manufactured Home
g
&
wg�
Other improvements
(6)
Test improvements (11rie 4 through lino 6)
(7)
Total value (fine 3 phus 11no 7)
(8)
I hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Eignature of Auditor
Date signed
M STANDARD'DEDUCTIONIALLCYWANr-E,�,W OMS'x,W�,g�Oft "W
20_ Pay 2O_ I
Lesser of 12 Homestead
Valuation or S35,000
Signskire Of Auditor Date signed