HomeMy WebLinkAboutHomestead_CooperCLAIM FOR HOMESTEAD PROPERTY TAX (� FHORM YEAR
CREDIT/STANDARD DEDUCTION HC10 �{
State Form 5473 (8614-03) n -_
Proscribed by the Department of Local Gowmmem Finance
INSTRUCTIONS: See r,:v%; ao dcb brMV kn&ucNarm. `AM}'f' SEP 2 2 2006
I (We) LJ certify that on theist dd y f 20
c n rr'3�UNT� fife
I (We) occupied as our principal place of residence the foil n ascribed real pr arty for which a Homestea@F'ro�fiy'fac Credit is hereby claimed:
01 (We) owned ❑ Are buying under contract
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 centract.
..1:... zn t,'} a. CONTRACT. - RECORDED%' s` ct�. t;-- s.. r'- i�ry „`°sh'.-'r�.-"ir`;C.-�'+ -Ija,'
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
..>.t.•Y -r.. "s -pt .° ,- —, . , r. -' c�3z*'�:�� PER, ; �D- - SCRIP- T - 0N r2. : Z . t�,uy- c.:..., _ts. 'Q- e `'.a,.t_s.x,µ,7.a' '� -Yt.s�:c'�. >,u-�.�• -r w . w
County
Tamship
T isldct (dry, fo hip)
Paroel number
a
soription
Is the prepe in question:
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I
Dropeny ❑ Mobile Homo ( /.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceedi gone (1) acre that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce income-
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- .$,ti -'ad.: -�,:�� .rPROP.ERTY >OWNED';BY CL'' AIMANT :INOTHER'COUNTIES,r`r*..�'c`� s�= r'I7„��?..s5.sr�- ��..�+h
County
Township
County Township
hereby certify the above statements are true, correct and complete.
Sine atu or of ant
Mdress (number dstreet, city, state, ZIP Code)
7 S, wtr/WgV D�
ORMS
SSOR USE ONLY' - r�,,.
;
ASSESSEDVALUE
"ATy100
O. HOMESTEAD ''.�`'fNON-
�% �f
y RES07EHT1_AL �)
MIN
YA_LUEi�tt.).)
.._e
%OF;M
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oe.�✓•.eVALUEP'
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Land not exceeding 1 (one) acre immediately
µ'3 *9 i1'
surrounding residential improvements.
1
O
,�I="•�
• '' '-•` "'•`� I',,p�yy,,.'
v
Other land
"d
(2)
riT'r
Total land (line I plus line 2)
(3)
Dwelling
rr�zi
�
'Residential bnproements or Annually
(4)
Zasa'eak�-0Wr' E ,
Assessed Mobile I Manufactured Home
Garage
5
Other improvements
(6)
a� f
£
Total improvements (line 4 through line 6)
(7)
Trial value (line 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
• .v�"z1 „�. 7: x' S ;S; STAN DARD.DEDUCTIONALLOWANCE. `”` - Abk�
211M Pay 200
Lesser of 1r2 Homestead TS
Valuation or 535.000
Signet re of Auditor Date signed
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