HomeMy WebLinkAboutHomestead_Holzmeyerr; CLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
t � S�aie Form Sa73 (Rfi / M3)
Prescnbed by the Department o1 Local Govemmen� Ffnance
� INSTRUCTIONS: See revasc sfde !o/ lilinq insfrucbnnti.
_ ��t�.;a�....�....t,s-o•.::n:-`=:'mr.,y,.:-. r- _ ._. _.
'_
FORM YEAR
� � HC10
i`�`,?�: �.�n:.�,._ .,_, . __..>9:..,.. �-:: -., . _.. . .. -CERTIFICATON STA7EMENT.: - _... . . _
:.._g�: -1: �-;/��J... ,.:. - - .
��e� certi��t o� tl�e Z��y of March. 20
I(We) occupied as ur principal place of residence the following described r roperty fo hich a Homestead Property T�c Credit is hereby daimed:
❑ I(VJe) owned ❑ Are buying under contracl •�� �
��-� p ��
Have a benefidal iNeresl in the entity ihat is liable lor the pmperty taxes on the property and that owns the pro� or is mg under a contraU.
il buying on wntrad, Fee Simple owners name
Recorders oifice where conVad is recordetl
Record number Page
;�s=% `F,.l =a=� . . . ....:.......: . . _...,�.;. - .r�. �::" :"FROPERTY DESCRIP.TION^::.� . . =z... . 7:..; ... . . �, t... _,,,>-.:
Cwnty Taxnship � Tacing EiStric� (ciry, town. rownship)
P I ber L g I des 'ption Is lhe pmperty in queslion:
�� ❑ Real pm0erty ❑ Mobile Homo (I.C. 61J�7)
If any portion ol e residenUal sWCWre a Ne nd not exceetling ane (1) aue Nat immediately surtounds Ihal sWCture is used b produce income. desctiba Na use and ponion
ol the property uWizeE to produce i(xome. /� �/^�
C/� /`"�
Kr�::;':�'��`^�`'',i t ;3�c,�'?;"` -;FFiOP.ERTY,.OWNEU��BYCLAIMAIJTiN��.OTHER'COUlJTIES�r t 7aE � . �.-> ''4r
CouMy ' Twvnship Counry �Tawnship
1 hereby certify lhe above statemenls are W e. covect and wmplete. i9nature ot claimant
� �i
Addres (number and stree(, ciry, sfate, ZlPcode)
u 1-: K o Q e 1�v K') �
�'�'' � �� - --y-TRUE�TAX - ASSESSEDYALUE �. HOMESTEAD:` � � NON;RESIDENTIAL';,
�-
- ;,
,p`.#"�i'��'',�c`ASSESSOR�USE�ONY -.. '�- e- ,.� �
..�.t.
:.. S.=a--„ � �,. . � '.- •- VALUE - `AT100%'OF�.TN: VALUE- --,i `..-SF.VALUEi "�•:-. .
Land not exceeding 1(one) acre immedialety .-. '�-=�.=;'^"" "-• --"�° �
surrounding residential improvements (�) . �. ' ' �
Otherland (p) - - .,, .
Tdal land Qine 7 plus line 2) (g� �
Dwelling (4) �': . �
Residentlal improvements or Mnually '} r{ "� �'F ��-
ASSB55Bd MobilB / M2nu(2GtUred HOmO :;f'�-i .?,;-��;; .; _ . � - -
Garage (5) �
Other improvements (6)
Tdal improvements (line 4 fhrough line 6) �7) � �
T�tal value (line 3 plus line � (g�
I hereby certi(y the above i5 We, wrrecl, and Sgnature otASSessor Date sgned
complete.
Vrntying aclion - Signature otlwtliror Date signed
" _-.ar-n'-: - -��>STANDARD.DEDUCTIONALLOWANCE`�`�� " -
20_Pay20_
Lesse� of 1f2 Homes;ead
S
V�uaUOn or 535.000
SgnaWreofAudibr ' Datesigned I