Homestead_RileyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
S�te Fpm 5t73 (R6 / d-03)
ProsuibeE by Na DepartrneM d Lxal Govemment Finance
INSTRUCTIONS: See �everse side Ior filing ins6uctiw�s.
FORM ,� R
�G HC10
� �...J
� JUL 3 1 2006
I(We) � �� certify lhat on Ihe 15t day ot��-h �� T(
-�n� rpUlv`I_7"'p.'.Qn�
I(We) occupied as our principal place of residence the following descnbed real property fo ch a Homestead Property3at�,YeditYs hereby daimed:
❑ I(We) owned ❑ Ne buying under coniract
' Have a benefidal interest in Ihe entity that is liable for the property taxes on Ihe property and that owns lhe property or is buying under a contraG.
I( buying on coniraa, Fee Simde owner's name
Recorders olfice where contraq is recorded
�+nN Tamship Tating distric� (ciry, fown,
Parcel Legal de cn tia ls ihe ro
�� -b �oa �� � �-3-I P �m
If any portion ol the resitlential aWcture w the land not axceedinp one (1) acre lhat immediatety wrrounds Ihat s i
ol lhe property uliiaetl W produce i�ome.
iL11t.Piy � .�/ - / �_n/_ �i.n - ran a. 9na _ nai
co��iY
Tarnship
I hereby ceAiy �he above statements are W e, cortect and complele.
�
Address (num6er and sbeet. cif}; slate, P co�,}
,/T,R.3 OWe�s✓��/P.La<<✓. /,°%, l�v
Coun�y
°�/� p,M�
Rewrd number
al propeM LJ l.lobile
is usetl to proEute income, �
Twvnship
Page
use aiitl portion
+�7,^-T'�, R; -�"� -F't '� s+_'�'� i'�'TRUETAX �� ASSESSED'VALUE +` HOldESTEAD� � NON�-RESfDENTWI
,. ^`�- � 1ASSESSOR USE ONLY j��� � VALUE'cr�.y'�'�Ca "AT..100%AF TN� "'�„y, VALUE ��5 nVlLLUE� di��
�i: 41�.�'.2rri.Y - }�(..Fk'' = ' �j' ��,.... _ . l.r. .+- _ ifin+T_T._..... .....� �:. nt��S.. ..�r,?Tt�
Land not exceeding 1(one) acre immediatety � �`�±-�"�' �z��
surrounding residential improvements. � �
� n����3�������-�'
���
Other land 2 a` x'£�'��+"
. . ( ) ���� ���
Tdal land (line 7 plus line 2) (3�
-�+� �� �s ._.—�--ec—:p-
Dwelling i4) �' �.:e� s : �t.,«� �`'i"
�Residentiel improvements orAnnua�y '��YY^�`� -�''��°' ��
0.ssessed Abbile / ManufaQUred Hane Gara e �� 't� t x� .:; a� ?�
9 5 � �+ ..�. :'n t'�$�'c�r � ����
Other improvements (6) +�,�y �-����'!
� � � ��.
Total improvements (line 4 lhrough line 6) ���
T�tal value (line 3 plw line n (g�
I hereby ceAify Ihe above is We, correct, and Signature otnssessor Uate signed
complete.
VerifyNg action - Signature oflwditar Date sgned