HomeMy WebLinkAboutHomestead_PullumCLAIM FOR HOMESTEAD PROPERTY TAX
CREDITISTANDARD DEDUCTION
Stete Fortn 5d73 (R6 / 4-03)
Pmxribe0 by Ne Department of local Govemment Finance
INSTRUCTIONS: See reverse side for filirg ins6uctions.
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I (We) ��/Jil/l� �[�(.t}[/u,(/7►\ `I l/CY{/U.C.(.(rl1C!% �, ti
I(Wey� ed as our pn cipal pla res ence Ilowing described real pmperty for which a Homestead Property T�c Credil is hereby d�a}me�:�
(VJe) owned ❑ Are buying under wn�ract Q PR 2 1 2006
Have a benefiaal interest in lhe enGty that is liable for the property taxes on ihe pwperry and that ovms the property or is buying under a contraU.
FORM YEAR .
HC10
I( buying on conVaa, Fee Simpie awnefs name
Remrdefs office whare conVaq fs recordetl
Record number � Page
Cwmty Tamship Tacing disl' ut f , tow
�a n_ �/�.�ro � O Legal descn0�on Is the property in quesuo .
�l / ¢al properry ❑ Mob9e Homo (/.C. 61.1-7)
If any ponion of tl�e resitlentlal sWClure w the Wnd not axceeding one (1 � aae lhat immediately surtounds ihat swUUre is used to produce income, desaiha the usa and portlon
of the property uti¢ed tn produce i�ome.
Counly
Tavnship
I hereby certi(y the above statements are true, corred and complete.
Mdress (numbereM sbeat cdy, s(ate, ZlPCode)
�.h�n � nn _ _ � fL �._,.._„�_
Land not exceeding 1(one) aae immediately
surtounding residential improvemenis.
Other land
Tofal land (line 7 plus line 2)
Dwelling
�Residential improvements or Mnuaily
0.ssessed Mobile / ManuFactured Home Garage
Other improvements
Tdal improvements (line 4 through line 6)
Tdal value (line 3 plus line n
I hereby certi(y ihe above is We, corred, and
complela.
Veriyirg action - Signature of fwtlitor
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(z)
(3)
(4)
(5)
(6)
(�)
I8)
Signature of Assessor
County
ol claimant
U�
Tavnship
signetl
signed