Homestead_Dike (7)CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fortn 5r73 (R6 / 403)
Prmvibed by tlro DepeMbnl d loral Gownment Fmarice
INSTRUCTiONS: See re�aras tkls kr�np ietbucdoro,
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I(VJe) certiryth.�a��-�/�n ihe� o( March, 20
I(We) occupied as our pri al place oi residence the following desaibed real property for which a Homestead rPopert�mc Cr�e�i Is hereby daimed:
I(We) owned fve buyirg under contract
OIBSON COUNTY AUDITOR
, Have a beneficial interest in the entity ihat is liable (or ihe property taxes on ihe property and fhat owns lhe property or is buying under a conVact.
If buying on conVari, Fee Simple owners name
Remrdels olfice where contraq is remrded
� � � "' , t' � x ` �_ n' . t � � 2 ' '�.' "t + = . � s ; � S ?�. Y�` . �i ' J E� i _5�L' �' � `t�� +SE
Counry Tamship
Parcel numher
ts ihe Droperty in question:
Retord numDer � Page
U1,7 -U Y C-� 6"/- �o) I/� 1' /V L 7'.S -/ oZ � .�� v�ooe�+v ❑ �.+�bna Hw„o u.c. s�. �-n
H any ponion of Ne resiCenllal sW cture or Ne land nd ezceetling one (1) aae that immeEiatety surrounds that sW cWre is used to produce income, descnbe Ne use antl poNon
ot ihe properry util¢ed tn produce income.
02Q�L�
Coanry
Tavnship
1 hereby certi(y the above sfatements are We, wrrect and complete.
(number end sLeet, city, state, ZIP cade)
of
-,�.�s.�.-''1'.a���`- �'��R•��'.°,�u„�3i�-�nv�#>'�;`STANDARU'.DEDUCTION'AL'LOWANCE-•a�%.'a�,,�'.¢�`+�'i�"�,..�'`'."��s.'�t+-'.'v,�,�i;s"'���y7�",'�-a`,Qi.''=^�'
. . . . . .. . . ._ .._ . _
20_Pay20_
Lesser of 1!2 Homestead
wuanm a 535.000
S
Signah�re of PLditor � Date signed