HomeMy WebLinkAboutHomestead_Corne (2)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Forth 5173 (R61 a-03)
Prescribed by the Department of Loral Govemment Finance
INSTRUCTIONS: See reverse side for filing inst uebons.
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JUN 0 1 2000
I (We) t t orvihe da"of ch, 20
eQlI�StJa. ..,off yJ.,, ff
I (We) occupied as our pri cipat place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ l(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 contract.
ii;n<CONTRACTRECORDED'.e W- i3.'..'4 "..
If buying on contract. Fee Simple owners name ,
Recorders office where contract is recorded . Record number Page
u':is.'- "- a- 1".•'',. P,ROPERT,Y:DESCRIP.TION Y
#."�"-- �,s >;sG6?°"s'v''•' -fir '" =�`"- �cHS+.rsu:'�'°
Court
County Township
I hereby certify the above statements are true. Correct and complete.
Si, gnature of cl i n
Toamship
Taring district
y,
wnshi )
yaryefr[,fJmbg(,r r r
Legal description
Is the pro
m uestio
_�
surrounding residential improvements.
of 6or
al pr rty ❑ ila Homo ( /.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre loaf immediataty surrounds that sW ure is used b produce in e. describe the use and portion
of the property uWized to produce income.
Other land
o ',.rS.'�a��r:'`ta'ix,'.t:g `f.PROP.ERTY:OINNEDjBY CLAIMANT;
IN,`OTFIER.COUNTIES`e�.:`,';<.r � -�'� -
County Township
County Township
I hereby certify the above statements are true. Correct and complete.
Si, gnature of cl i n
Address (number and street, city, state, ZIP code)
iizly e Sao 5.4k
AT %OF T7VHOVALUED5�
aYSM1n.M1V
n7aR'U' -` t�
ASSESSOR -USE ONLY `ts'`j
L•y .-TA 4v
'TVALU��`'
E00
_�..,.., 1=
v5ef at
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i+.�..
AT %OF T7VHOVALUED5�
aYSM1n.M1V
.iwtf?
VALUE�L�•.'.
�a 'Iniw.j
Land not exceeding t (one) acre immediately
u on or 535.000
Y S .
surrounding residential improvements.
of 6or
Date s' —0/ -0
Other land
(2)
�`, x"r'
Total land (line 1 plus line 2)
(3)
Dwelling
iResidential
(4)
improvements or Annually
Assessed Mobile / Manufactured Home
Garage
5
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 phs line 7)
(S)
I hereby certify the above is We, correct, and
Signature or Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
.._ �, �_ �;�,'i..x`rx'�fF•f' TANDARD':DEDUC1IONA1:COWANCE;,.�,:,:M;�;;IS..�2`-
sib- =a?r,.?;'�.",+t'.,�r�a�;`Y'd
20 _ Pay 20
Lesser of 1r2 Homestead
$
u on or 535.000
n
r
of 6or
Date s' —0/ -0