Mobile Home_Wyattr
CLAIM FOR HOMESTEAD PROPERTY TAX
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SeFR614-03)
Prescribed by the Department of Loc I Government Finance FEBINSTRUCTIONS:See revcis° ide for filing ins truchuns. r C 2 5 2005
e ,}e{ t:1... •` :: �- "" - . ,_- c RTIFICATION STATEMENT . - -
W.
I(We) &, '. �. .� ti. 8
certify thOIBS®M LiO w;litv>7It01�R
I(We)occupied s our principal place of resid the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned 0 Are buying undAAAAAAvv�����000000ntract
..-r-1 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
)ci1,110- &54.7rt,-) .,.,. Siii)±_. r.a .-aE: CONTRACT.RECORDEO"_s-.....-
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
aa-zc E.F.`?.' u., -c,- _w it-..-';PROPERTY DESCR • ION:_,' _.. .r .
County / k.5 Toxnshlp Twin!/I y,town,t unship)
O
Pour/ i• berr AL
-I //�6 L p,�Y{e�p /� � Is the prop in• estion:
( �p '`7�(�I�j�� //J/T/ /1 i=ea property Mobile Homo(LC.6-1.1-7)
aryportion of the residential structure or the land not exceeding one(I)acre that immediately surrounds that if,' re is used to pr ce income,describe the use and portion
of the property utilized to produce income.
tiWirttat '?:.:t: .5 a„ " '-- ., PROPERTY OWNED BY CLAIMANT IN OTHER-COUNTIES : -'45: "c. -
County Township County Township
I hereby certify the above statements are true,correct and complete. � s1b�Signature of claimant , , (lam'-'-
dress(number and street,city,state,ZIP code)
y0 1 ELM ST, tf,�bb +4d +,1N Y763`j
TRUE ASSESSED VALUE : HOMESTEAD NON-RESIDENT IAL,,. tASSESSOR USE ONLY . • AT 100%OF TTV- VALUE >;=VALUEr .x�-sti St v _,...s.=-i-:- - VALUE
Land not exceeding 1 (one)acre immediately - - -
surrounding residential improvements. (1) ,
Other land (2)
Tctal land(line 1 plus line 2) (3)
Dwelling (4) •`-i:�.-
Residential improvements or Annually - .iii````r't "''"''==" ' '�
Assessed Mobile I Manufactured Home Garage (5) ti r
Other improvements (6) S
Trial improvements(line 4 through line 6) (7)
Tctal value (line 3 plts line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of wditor _\\ �I Date signed
GO \ 1\\ €4e
r a,. . \ *1.... _ STANDARD.DEDUCTION ALLOWANCE
20 y 20
\ �' Lesser of 1/2 Homestead S
vauauon or S35.000
Signature of Auditor Date signed
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