Homestead_Nelsona0 "'q
.: e CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
� � State Form 5473 (RS / 70-01)
Prcscribed by the Departmem of Local Govemmem finance
INSTRUCTIONS: See �everse side /or filing insWctions.
I (We) /\ certif
I(We) o ie ur prin i al pla f residence the following descnbed real property for which a Homestea�
❑ I(We owned ❑!ve buying under conUact
�'�ave a beneficial interest in lhe entity ihat is liable (or the property taxes on Ihe property and that owns the
If buyuig om m�uaa, Fee Simple ownefs name
Recordefs alfice where conirad is recorded
County
Township
Tacing dislrict (ciry, fown, township)
FORM � YEAR
H�,o �. 3
rly Tac Credit is hereby daimed:
FEB � 0 2002
y or is buyinw4hder a cflnVaat.
Rewrd num�er � Page
�
P cel nu�r_ o�aq g' — I Le9aI�,C/►��n ^`� �� I Is the property in on:
�+( J L a Real pmperty ❑ A7abile Homo p.C. 67.1-7)
If any porlion of ihe residential shuctura w Ne land not ezceeding one (1) ame that immetlia�ely surtounds thai sWUUre is used lo produce intome. desui6e 1he use and portion
of the property uWized to produce income. �^•/� ^ I y� `
ot r ► � �
-, �-„�_
������AS ESSOR��USE ON Y�� �` ��"� i}TRUE TA7C'�,w Np ASSESSED VALUE e��HOMESTEAD'�. ``���-h'� tNON RESIDENTIAL� �s-�'
.'b��...r�-�.`�`� �t�?".#'s3i..1..:+�-''�e"%�t+.'�t'� �-�,.,�VALUE�s'y,.� aAT>100%OF.TT.V.. �'v�-`_'�VALUE,.i`'-� c� ��v� ±"°,zVAI.UEy�`�"�x�'
Land not exceeding 1(one) ac/e immediately �_� �.��'+a ° � '�`��,?
*�- v
suvoundingresidentialimprovements. (�� v`�� �k��YF�.��F_-
S � �'i; x
Oiher land (2) � ���p � �.';
—f--�v y/.{
�AY xi.:�i�..l . _.�
Tctal land (line 1 plus line 2) (3�
Dwelling (4) zC'�'�;K� �µs` txt{���`�`Sc� �
Residential improvemenLs � '`�'�' �'�'�`'' "�'�''�`{
J#c`�x '��,�`t` ,��',�r,�N:'.
Garage 5 .'v � ' 1�`��`� � . :?�,9 i
� ) ?:-s�t�.1"°.tr�`::r�7...��'� .��r '
� ytix' �.
Other impmvements (6) �,r �' u ;
,,:���..,.i..
Tdat improvemenis (line 4 fhrough line 6) (7)
TUaI value (line 3 plus line n �g�
I hereby ceAify the above is W e, coveG, and Signamre o(ASSessor Date syned
complete.
Verifying actbn - Sig�mre otlw0iror Date sgned