Homestead_WilderCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Steta Fortn 5/73 (R6 / 4-03)
Prescribed by Ne Departmerrt af Local Gwemment Finance
wsraucnoNS: see ieverse side �o. r,rMy;nshuctiw�s.
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� � ORQ� YEAR
MAY - 8 2006
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I(We) occupied as our principal pla of residence the following scnbed real property for which a Homestead Property T�c Credit is hereby daimed:
❑ I(We) owned ❑ Are buying under conlract
' Have a benefidal interest in the entiry that is liable for the property taxes on Ihe property and that owns ihe property or is buying under a wnVaU.
If huying on contraq, Fee Simple ownefs name
Remrdefs office where conVacl is remrded
Record number � Page
�+��Y Tavnship Tating tlislrit� own, fownship)
Ppa�rce�l number Legal descnpUan s ihe prope in question: �
UV � � ea� properly ❑ MubJa Homo (/.G. 67.7-7)
It any portion ot the residentlal swqure or Ne land not exceeding one (7 ) aue that immediatety wrrounds that sw re is used to protluca incame, describe the use and portian
of fhe property utllized to produce income.
/
County
Tawnship
I hereby certify the above statemenls are We, corred and complete. '
Address (num6er and street, city, state, ZIP code)
� k•R,�l� �'1��. vu��sd/�, i.� G1� caf�
Land not exceeding 1(one) acre immediately
surrounding residential improvements.
Other land
Totai land (line f plus line 2)
Dwelling
�Residen6el improvements or Mnually
Assessed Mobile / Manufadured Home Garage
Other improvements
TUaI improvements (line 4 fhrough line 6)
Tdal value (line 3 pha line n
I hereby certi(y ihe above is We, cortecl, and
complele.
Verifying action - Signature oflwditor
ora,a�w
.20_Pay20_
Lesser of V2 Homestead
vauaUOn w 535.000
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(3)
(4)
(5)
(6)
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SignaWre ofAsseswr
Coumy
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0
Twvnship
Date signeA
Date signed
Da�e signed
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