HomeMy WebLinkAboutHomestead_HaydenCLAIM FOR HOMESTEAD PROPERTY TAX tj\ �� FORM YEAR
CREDIT/STANDARD DEDUCTION
Slats Form 5473 (R7 I S0M
Proscribed try the Department at Local Government Finance
INSTRUCTIONS: See reverse side for filing Instructions.
C ON:
1R11FICATI STATE1AENT,1,,T,,4!�
certify thaXt
�T t ja�jrrch, 20_
, sia
a
I (We) occupied our principal piece of residence the following d ieibk real property for which a Homestead Pro at t is hereby claimed:
) owned ❑ Are buying ..der contract
11: a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propert
y or ispuying ubder a contract
CONTRACT, RECORD
it buying on contract Fee Simple umver's name
PAcordeftafficti where conb clisrecorded Record number Page
V1M9W% M97;�PlfOPERTY 00SCMIM15N
County
Ti:mms Wip
l�ldrrg di T �( .1 t
l 5`� rl
Parcel number
a (�--C44
Legal descdpbw
1 9 - ap n
question:
pr ❑ Mobile Ff.. (LC. 6- 1.1 -7)
if any portion of the residers sal structure or the land not exceeding one (1) acre, that irnmedatety, surrounds that stdclure is Used to piodtJOB income. describe the use and portion
ofthe property uftmd to prodice inoorrie.
PROPERTY.OMEI)-BYCLAMANTtfNoTifEFt'd-ciuti�nEE§'$?,-r�,'�i��..VZ--,
County
Twnship
County Tmnship
I hereby certify the above statements are true, correct and complete.
1`0 in
number and struett ZIP cod T-Al
5
Z/ 76
an <tr 01
ASSESSOR 699 ONLY4 21
-k�KOMESTEW�j
"o 4.,-ygm;
$
Valuaboin or SM.000
SignatLat, of Amdrtor
Land not exceecling 1 (one) acre immediately
Vftt"&
surrounding residential improvements.
KN ,
Other land
(2)
NNE
Ticted land (line 1 phis rime 2)
(3)
Dwelling
(4)
.gqg
Residential improvements or Annually
Garage
(5)
WE _0 ON
Assessed Mobile I MansitactunDd Home
Other improvements
(6)
gn
16,
Trial improvements (Foe 4 ftough line 6)
(T)
Total value (fine 3 plus fine 7)
(8)
I hereby certify the above is true, correct, and
Signalise of A!1103S*,r
Data Signed
complete.
Verifying action - Signature of Acrd tor
Data signed
STANDARDIDEDLIC11OWALCOWANCE
20 _ Pay 20 _
Lesser of 112 Homestead
$
Valuaboin or SM.000
SignatLat, of Amdrtor
Data signed