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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
Y CREDIT /STANDARD DEDUCTION HCIo
Slate Fonn 5473 R817-07)
,. Prescribed by the Department of Loral Government Finance
INSTRUCTIONS, See reverse side for filing instructions.
I (We) —,G I jn V) a () C/ LL (certify that oW1&ay r3W&-c h, 20_
1 (We) occupied as our principal place of residence theZollowing described real property for which a Homestead Proper l(xTax Credit is hereby claimed,
'❑ 1 (We) owned ❑ Are buying under contract [;�q� .Q
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prape�bOpC/�yUlayortbact.
If buying on opmracL Fee Simple ownees name
Wr
To
amel number
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 Ke use and portion
of the propeM utilized to produce income.
•• •
rr
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
(1)
- -
Other land
(2)
Total land (line 1 plus line 2)
(3)
Dwelling
(4).
Residential improvements or Annually
Assessed Mobile IF Manufactured Home
Garage
(g)
Other improvements
(6)
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed (month, day, year)
complete.
Verifying action - Signature of Auditor
Dale signed (month, day, year)
77�_ pay 20
Lesser of 12
Homestead Valuation
Of n
45,000 for 2007 pay 2008 42,000 for 2010 pay 2011
44,000 for 2008 pay 2009 41,000 for 2011 pay 2012
43,000 for 2009 pay 2010 40,000 payable after 2012