Homestead_VirdenQ�, rt•na
��4 t CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
'� J State Fwm 5473 (RS I 10-01)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side lor Jiling instnic�ions.
• '
;L . . � � �.
; _
y { � 1 )
�(�'�e) � __�._L/C ��/C/ {� certi at on e 1 t d f Mar 20
I(We) occupied as r rincipal place of re � nce Ihe following described real property for which a Homeste � GI� �Y Al�bl , i ed:
❑ I(We) owned ❑ Ne buying un er contracl
�Have a beneficial interesl in the entity that is liable for the property taxes on the property and Ihat owns the property or is buying urder a contract.
��.�f�5���s'r�< ; ..."K'_%i� "t .:x-�; �.CONTRACT'RECORDED_a':,;' '}"�?'.,' ..=� -,
,_�
il huying on wnVad, Fee Simple owner's name
Remrders olfice where conUaa is recorde� Rewrd number Pa9e
County
Toxnship
Y" �U���/�JOf /% -tJU I �Ya�-S�i`I`- .J�o�—i � /� s me
L
1( any potlion of ll�e resiOenUal sWCWre w Ihe land not exceeding one (1 � aue t�at immediatey surtounds
of the properry ulilizeE to produce income.
/Y�� .
County
_1��- .
,'�PI
Tavnship
_ �o% ��7-a�/
I hereby cer�ify the above slatements are true, correct and complete.
cify, stafe, ZIP
MANT IN
County
Claimant
- ' -?;��'
,' ro�
Real proO�Y LJ blobile Homo (I.Q Gf.7�7)
ire is used w produce income, describe lhe use antl por4on
�.���� OpUS�ONL ��'�-rv'.`�c��u �1Ty�UE „ ,g,' AATE00%OFTN �.H�.VALUED� ����NON�RESIDENT�IAL� �
,�„ �, t- .,VALUEz t
. _ .. ...... � . ........ ._. . .. ......
Land not exceeding 1(one) acre immediately �� �7z�fY �€_;, '+� 3 r+�. �'..�',
surrounding residentlal improvements. (�) � t 5 '�'t��'���.��„z�;-?�n�k :•-
Other land - �=h�='' '. �:ct�
(2) ,.>F�;._
:� � yY�.
Tdal land (line 1 plus line 2) �3)
-.� „ .� ,�r r ^
9 (4) as vta..{,` � 1�.s _..
Residential improvemenls �e11in � � '� r ��' � '�'' ��r�� �� �'
Garage �5� �.� ������`�,"'ti�?Y:
s� ,'v- ^'� - � �,.,.,..
:�� �,-�,';^._.
Otherimprovements (6) - ' r. i;_� .,,
-,;i;::.::..r,...
Total improvements (line 4 through line 6) (7�
TUaI value (line 3 phs line n �g)
I hereby certi(y �he above is We, correU, and signawre otasseswr oate signea
complele.
Verifying aclion - Signature of fwditor Date signetl
'€.C.c+.�?`C � .n ' _ . � � „_, : -.. �. . - x .�Y:.+ -t .
�'°`r :�.y �.,.�: �.`.�-�� v.�-.'�� -t`;�':.STANDARD.DEDUCTIONALLOWANCE ......_.: ,..ys.. .a.'-�_ z..,_ ���,r.aEnw:..-.._,�..... _<
20_Pay20_
Lesser o( 1/2 Homestead
Valuation or 56,000 5
Signaturo of PuOitw Date signed
�rr _ _' _—__ ._- -