Homestead_Dewig (2)CLAIM FOR HOMESTEAD PROPERTY TAX
" CREDIT/STANDARD DEDUCTION
�t. . � Sfate Form 5473 (RS / 10-07)
��N Presaibed by Ihe Departrnent of Local Govemment Finance
. INSTRUCTIONS: See 2verse side /or Poing inst/ucfrons.
�� FORM YEAR
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i�we� .iUYUi�.C1X.1 �' �JG'L ee�t � )� �l �` �reyme �ma���Ypf'maa zo
,I--(W,�e) occupied as our principal place of res' nce lhe following descnbed real property for whicb estead Propeity Tmc Credit;��s,R ' y daimed:
4}' I(We) owned ❑ Are buying under contract
' Have a benefidal interest in ihe entity ihat is liable for the property taxes on the properry and that owns the propeRy or is buying under a contract.
If biry'ug on conVact, Fee Simqe owners nama
Recorders ofice where contraq is recorde0
Remrd number � Page
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County � 7avnship 7a�ing disVict (dry, town. townshiP)
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P�I number _ _� L descri Gon ' Is Ihe pmperty in question:
� ' [�R�eal property ❑ A7obile Homo (I.C. 6f.f-� .
H any portlan of ihe residentiel strucWre a the land not exceeEinp one (1) aue ihat immediatety wrrounds Nat swGUre is used to protluce inmme, desuibe Me use and portbn
ot the propeAy uL7¢etl b produte i�Ome.
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��`' ���`�-���?���'`aPROP.ERTYjOWNEU:BY;CLAIAAANT:IN;OTFIER�COUIJTIES�,�nS'�,:�3`���:
County Twrnship Couniy Tavnship
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I hereby certi(y the above statements are W e, corred and complete. � atur t Gaimant
Address (number and sheet, city, slate, ZIP code)
� � �'�� '"��'-s`�' � �� TRUEaTAX���a. ASSESSED�VA�LUE �HOMESTEAD��''�' NON=RESf�EN� AL �
�+-F�'�� . .,� � �A �Eq.�,�R�.�,���r,. . � . � �'�r',,VALUE�'�#� � �AT 100°k'OF�IT/� y�.�i �..VALUE� .�'�;i'., VALUE��-.�'��
Land nol exceeding 7(one) acre immediatety � ��`�u� �%� �
surrounding residential improvements. (�� � a�„�-����M�`���„ �.x's
�.�" r4Y';_ .
Other land .. "`� �: `-;`-�
(2) ;-�='J�. .. :�
'ss�x��;
TUaI land (tine 1 plus line 2) �3�
Dweliing (q) ���ty-... �r - t::�� �`
Residential improvemenLS ,,,.�
„��„�,S::le��-�. ,r _�e,: :,sr�:
Garage �5� �s-.. ='��. s�-. ,-...,
+^>[34'r,�"' . ' �
�a��?c:s_� . `'.4: � ;��
Other impravements (6)
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TAaI improvemenLs (line 4 through line 6) (7)
Tdal vatue (line 3 plus line n (g�
I hereby certi(y the above is We, corred, and Signawre o(Assessor Date signea
complete.
Veiilying acl"nm - Signature oflwditor Date si9netl
20_Pay20_
Lesser af 1f2 Homestead
Valuation or $6,000
5