Homestead_Forcum. � CLAIM�FOR HOMESTEAD PROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t 5teta Fwm Sd73 (R6 / 4-03)
' Presaibe0 by tha Departrnem of Local Govemment Finance
� INSTRUCTIONS: See reverse side lor filing ins6uctions.
--�,
� OR YEAR
cto '
JUN 3 p Zp05
I(VJe) ' �:' v K�j�'! ttab�nNthe 1�y oi Merch, 20
I(We) occupied as ur prindpal place of residence the following describ real property for which a Homestead Property ��c Bi�BdIIpj{ereby daimed:
i] I(VJe) owned ❑ Are b�ying under conUact �
, Have a benefidal interest in the enlity that is 1ia61e for Ne property texes on the properry and Nat owns ihe property or is buying under a conVact. �
If buyinp on coniract, Fee Slmple owners name
Racortlefs ofice where contrad is recorded
Tavnship
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Record numbar Pega
' -° "� - 'i'-`e'
� Y t
fONT, fON915h10) � /l
rV�',J OO('�OIY'iJ L��l�(� 30 �/' IISNeP�I
i
tl eny portion o( the residentiel strucWre w Ne fand not exteeding one (1) acra ihat immediatey surtound5 that
W Ne property utllized to produce income.
al properry ❑ Mobile Home (LC. & .�
is used to produce Income. describe Ihe usa and portion
�.-�..Y`�Srl� ASf-.r4"�'+,.d . �.�.� .0 �is . , .' _ �x . . _. _ SS �-" ' xss R
. in�.�''s,�,�±�ASSESSORUSETONLY �'�;-"-�k,S'',���s�v�-'��UETAX.�� ASSESSED�VALUE ���HOMESTEA�-`���=NONRESIDENTIAL ,�.-,-
�....���+�,LT.;�.^4�Yrbr..4...;�.�.'�a:'•?'�`-�'c�. .�•z?n�i,.:`r�2>VALUE��t. AT:100%OF-TTYs�� =cVALUE�. � ..,„;VALUE.r:?��-,:>�,v:
Land not exceeding 1(one) aue�immediately ;�p v �.� "4 ; tf � i;
. surroundingresidantialimprovaments. ��� ,,,. ,t��-„ -=Y,:3,." ��.
Other land (y� �
Tdal land (Ilne f plus line 2) �g�
,. � �+_ '� �� .-' nt `-
Rasidenlial improvements or Mnually �����9 (4� 'i ? �;,b � � � - ?.-
Assessed Mobile I Manufactured Hwne =:?'r �a-sr:*; :°�:.�s•�x. -,v�-. _.:_;. .'
Gara9e (5) '� � �-ry 1 ` -
•Y'' . �. . . 2 '..
O�qer�improvemenLS (6) :
Tatat improvements (line 4 through lirre 6) �7�
TUaI value (line 3 phs line � �g�
I hereby certify the above is We, correct, and � Signawre of Pssessor Dau signed
complete.
Veilying eWOn - Signatura of Auditw Data signed
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation or 535,000
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