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Homestead_PohlCLAIM FOR HOMESTEAD PROPERTY TAX CREDIT/STANDARD DEDUCTION smm r� ure rta i son� PreanbeC by tha Depertrnent of Loml Gouerrvnarq Frenm iNSraucnoris: s� ��re� �;aa �. r��y ���,�. � I : • �� _ � } � %I'` rvuv 1 3 2001 ' � �::;. ;� `: � �^'e> �dl�atsD`C7lar'�!�"eovfbla�• �— I(We) ocaped as aa prmdpaf plafc aF resider�ce the foAowi real propert�r for which a Hanestead Pmpaty Tmc Credit is hmeb� dairtied: ��(We) owred ❑ Are buy'v�g unda oontrad Have a ber�efidal mterest m the entity tliat is liade 4w Cie popeAy taxes m the property ard Mat ams C�e property or is buying urder a contracL ':.5��:..♦ ' : .Y-.. �v/ 'CON7RACT:RECORDmn s °i(.I,at :?in c�.` �r1 -;f: n Wyeg m mntraq. Fee Sir�le wmefn rerre � fbmdds dEc� whae m�had is remded Recod number Pege -. _ �. . . ,.., ..,f ..„?'°,4- Tonsldp � �'�'�ii-a� 3rb a a-�al ���' n eny por4On au,e r�ideMial sfi�cEUe a a�e I�d na �eedin¢ ona (1) acre mst :nmeaaoely wrtw�m u,� d Ne ploperty WiFmd b yoAra e�mrt�e. County rwnship I IIEBby Cefhy B1e 2bove StaAelflPlliS 8fB (I118. COlfBU 8fld COrt�IQ�. (nl+rbw9rd�seCadl:sfa�e.7lPmde) , . County �w�r u�ab y�,� p.c. u,.,-n usad b V� i�aoma. tha �ae md portion . . � A§S�RSOAUSEOMLY': .. �p�� ;� 7irilE;TAX AS§ESSEDVALUE t�L'ff_STEAD`.. : °'NON�87ML�;i"nW, ,i..... .,..,.r.. . ' .....�, . 3ti.�. VALUE�.,.. 'AT100XOFT7V .^;aVALIfE xY'•..ifn„-t�'?ti;`��+V/ILUE;...�. sx�";'.4.: r � c larW rwt excee�ng t(one) aae imr�atey � �?a n��.. a�r � rA �: q kss �X s�RfamdRlg RSidenfial implovert�erl�. (�� �;i ' � .,.,#v#', � . �'S4�;r1'` �!�� N! Olhalard �2) ,�_.�� ,4 r:���,� Td� tand (I'me 1 olus fine � i3) s °, t riE:� Resdential cnprwer.ient5 orMrwally ��� �4� ". e��`'r �:��L i?�''l t/,�, 'Y� yr1y1J Assessed Alodle ! A1arn�red Flane ' N> ��'r� a �° r 7'a Gaf�9y (5) r�:�'73�uk�fi'N ��� �+°!i 7 � ���.1(�'i, _, �t�, s.aMti�. �.Li S��a 1�..��".'�3�.' \ .,+.�4 ^�. f� ,. �ICf IRIPfOVMf1f.Y1}5 �6/ f...:J::,. � ...y .::�.!�:. } - Tdal'vrry�ovemertts (iire � tivou� ffne 6) (7) Tilal value (!'vre 3 pks Gne n (g) I herPby certiy tl�e above's true. mred, ard Si�ea mAc�smr Dam s'gad �� Vaityi,g aaim' Sga4ue of NMitu Date agned y-: 20_Pay20_ Lesser of 12 Homest�d Vahiation or 535.000 E I �`°`7� - l.3-�7 I �_� � --�--z-� -- -- - --