Homestead_Henderson (2)CLAIM FOR HOMESTEAD PROPERTY TAX
- s � CREDIT/STANDARD DEDUCTION
Stata Fpm 5473 (RB ( 7-07)
S�o. � Prescnbed by the Departmerrt of Local Gwemment Finance
INSTRUCTIONS: See reverse side lor �ling instructions.
r ���
.�- ,
a , ; � i:�_�
AUG 0 7 2008
I (VJe) �X�.Jt.C-/�� �(Ll / certify th�l'Brt'M�'t�sf-1�pbr�tvt2fiRJI�BR
i(We) occupied as our prindpal place of residence �he following described real property for which a Homestead Property Ta� Credit is hereby daimed:
I(We) axned ( � Ne buying under mntrad
Have a benefiaai interest in the entity that is IiaWe for the property taxes on the property and that owns ihe property or is buying under a contract.
It buying on coniract, Fee Simple owne/s name
wnirad is recortleE
Counly
Tamship
town. to�.vnshiP)
Recad number � Page
Pa�cel number Legal descnpUon • i(r fi L Is the Dro�rry in question:
Pr � s E 4- 3-� � �� � Real prope ❑ Mobile Home (IC 6f.7-�
If any ponion of the residential struclure a Ne tand na erzceeding one (t) acre Ihat imm�atey wrtounds Uiat structure is used lo pmduce inmme, descnbe the use and portbn
af Ihe property uliGietl tu pmduce income.
a� _,� _ o�_ y�o , oo�. so 9_ o��
,_ , . . .. . .
„.. '
Land not exceedirg 7(one) aae immediatety -
surroundingresidentiaiimprovements. ��� . . � '
Other land �Z) . . . ..
Tdal IarM (line 7 plus line 2) �3�
; _`ry. . . . .
Residential improvements or Mwaly
Dwellin9 (4) - -
Assessed Mobile 1 Manu(acWred Home - .
Ga2ge (5) � . . . .
Oiher improvemenLS I (6) .
Tdal improvements (lrne 4 through line 6) �7�
Total value (line 3 p!'sline n (g)
I hereby certify Ne above is We, corteU, and Si�nawre otassessw Daie signed (monm, day, yee�
complete.
Vailying action - SignaWre ofAuditnr pa(e signed (mmih, day, yee�
�.-� � � • •
2 pay 20 _ qg.ppp for 200 _7,. pay 2008 . 42.000 for 2010 pay 20N
Lesser W 12 qq,000 for 2008 pay 2009 41,000 for 2071 pay 2012
Homestead Valuation $
« 43,000 for 2009 pay 2070 40,000 payable afler 2012
Signature of PLditw Date signed (nra�th, day, yea�