Homestead_SteinerCLAIAA FOR HOMESTEAD PROPERTY TAX
CREDR/STANDARD DEDUCTION
Slata Fortn 5173 (R614«i)
Rmaibed M the DeDaMrorit d Laxl Govemmant Finance
INSTRUCTIONS: See rowrae adda b l�p iuEtc6'ona
FORM �
YEAR
�(We1 �/��1� Q�1 ��%� �' 7U �%!/KJ J�%'lXX/�-�/C � certiry Ihat on the �st'd"��a �
I(We) occupied as our principat place oi residence the (ollowing descnbed real property for which a Homestead Prope���c ' y piaimed:
❑ I(VJe) owned ❑ fve buying under wntract AUDITOR
� Have a benefidal interest in the enliry that is liable for the property taxes on the property and ihat owns the property or is buying under a wnVaU.
If buying on conVact, Fee Simple owners name
RemNers otfice whare conirad is recorded
Toxnship
the
6�SX> F//c—JC.v / 'i `� 17 �G� Y�(i !/i / ci � /� I
I( any portia� af Ne resitlenilal sWdure or the land not exceeding ona (1 � aae Nat immediatety wrtounCs
of the propeny util'vxd to poduce i�ome. /D �j
L/lJ
Remrd numher � Page
i quwtion_ U �
Reat propefty ❑ MobUe Homo (I.C. 6f.1-7)
ue is used W produce inwme, desaihe Ne use and portlon
I �l-/� ���-5`a�-�/.3G7-o�/ I
'S-��=�"5�°"���""� '��, � "' -�s �pSBESSEDVALUE �HOtdESTEAD � �"" rL�NON-RE5I0ENTIAL�"'��d��
" "i 1 bAS5ES50R USE ONLY } � �TRUETAX� �
_ �"x��s ,� �yP �.�„�.��;�x���.� �'-��,-wVALUE�sx � �`AT 100% OF�TSV� r,,j�,�.VALUES,�.� �� �'s�VALUE �g?"���
Land not exceeding t(one) aue immediatery ""+�� �� =':�"�'�* '� _^��-�r+b�
surrounding residenfial improvements. �� � .=�''t �"`" "� `�� Y-� � ��i'
�-������r
Other land (Z� � �,:F,e`'�`���ixK,�� .
.� _,�?�ja'
_ +�w:.: Y.:'`��•'a �;
Total land (line 1 plus line 2) (g�
r...�, es �'�y�i""-, �x
Dwelling (4) �3��� ���"� �
'Rasidential fmprovementa or MnuaOy � �y
����
Aaxased Mo60e / Manu(a�red Hortb Ga2ge (5) :���t ��-vi.�r�
o«�i �"�' `+-e1
�� _ ���
Other improvemenls (g) �'.3 '3'��`� �"-s� •
�: s'_��.tu
Tdal improvements (line 4 through line 6) (�)
T�al value (line 3 phs line � (g)
I hereby certi(y ihe above is We, coned, and Signature ofAssessor oate sgned
complete.
Vei(yu�g aclion - Sig�ture oflwdiWr Date signed
��-�-,�'�'-e+:�.'.�R�"_-'��=�3�5.`S�.r�n ��''�c��.c:cw.�°�:��ff..r`STlWDARD'DEDUCTIONALL'OWAlICEta_�'�+^„�'+���t�.E,,.:'�s"„•�u`-'""�-'T,'re�`.-'���..'�`s�',�`"�.„a-;c
20_Pay20_
Lesser W 1/2 Homestead
vaWatan a 535.000 S
Signatura of /wdita " Date signetl
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