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Home My WebLink AboutHomestead_Wagner (3)---CLAIM-FOR�HOMESTEAD�PROPERTY"TAX,�,:� ---"-- f�G'� - FORM— YEAR.__. �c.. ..._r .t,o_��tota Y�` - �-CREDIT/STANDARD-DEDUCTION�=�=--=------- -\ — - ---HCto --' ; �• SlateFOrm5473�R6/403i A.Oa"-1'.i-i?:1: .+:9'u<'•.al�vr n rtivl..:.�y -:7 ! -,�'4c.i"ilie��wC`J'�ili..'.Bl. 6!:'�.A.G.�]: `.i ' ' t ' ...T � I Prescribetl Oy the Department ol Local Govemment Finance' ' ' ' . ' INSTRUCTIONS��See�reie'rse�"sid'e'lor`filin'g ns`m"icf oris!"y"� E�.�'=^: `.n �=' a'r-:..�� " . . . . ' �` . .>� � iiL'�'�'15f+! fiti 15!17 �115QGY! �Ln: eo 546ivei"s?OR 3' 1=rti :,�r.: � bs;::re1Vn5.T� , s'1t:. .. .. �.. `i . .. � . . 1 e��'^ o ' i t, zr . r '• . s - U '. . ,}. .. cerLfy on the 15t ay arch, � i M' ) � L� /t �j�' � �I (We) occupied as our principal place of residence Ih ollowing described real property for whic7i a Homestead Rle6eHy+7a� �' �C ��.1 iv n d r'�, la �i �t; 511 J1rv a� �4-- (`ic.. E-. ��.!: t. .. /O �I�SC�r ..l)u'�VT�Y r.UiJI'CR . �.i� I (VJe) owned � ❑ Are burng under contract . � � ' ' .zsBiC41 ' .TJaS9u13r.fH�7ro �lr� b �Li- . �li � Have a benefiaal mterest tmlhe enLry Nat is�Jiable:for the�property taxes on the property�and Ihat owns the property or is buying under a wntraU. _ r.:i 11.;... ii or � _tim rn.��v , n�r hnm.. : ri.r:l � . , aqn cr�n. ^ t^ !c�. .. c. F.u. . r . . .� . . . . on contract. Fee SimD�o owner's name .......... ........... .......... ....- ... �..., . .. . . :. . of6ce where contract is recorded� �z sr�1'c, 2n;C�n ,•:•• -_- . .,: i � �� :;�� • � . : 4:, _ . � � :� C.r� _. `Counry"s:r.� n"' d;;::': � ��i --se� �S=:hs �x I a°;ii �.�.P,3 �-oo< :2i9 !sA�7 r�l ,.�iu.�G � Record num6er , , I Page num^b^er Le/�e 1ld,e,sc//q��p�'qn �J / —}I Is ihe O�oPertY in question: � —W �/9'� K /lLfL( [//1.� /�(�Q / � �Real pioPertY�� ' ❑ Mobilo Homo (I.C. 6f.1-7) oortlon of Ihe residenual structure w the IanE not dzceeCing one (1) arre that immediaf surtounds �Nat sWCture is used to produce income, describa Na use antl portion xoperry utilized tu produce income. z9"Zgi1 f..J]N�hi'I n5 ll .,�,aiEJ01 :Y• 655!%3,;:Od s(1 G:�::.: .pqua` 8-11 n g'.1.1 -' ..... , . _ - i: - . . . .�.i�io _�chc �a. v.;aueJ �r't,,, cG�13��^�+ esan�sl5 ^n._s,uC� Y3z ri n. ..7�1z . _ -- _ .. �di sy":is r�oi�cc 9�'T .ira� ssh�ihso a rv bt�Gle��ro' �s��:,cra s r.. ,�. _ 0��942n.^.� s,J P:., ::C:. � c . . . . � . . CountY:zlrtsnc:sz tns+.a��!: ?�'m i_ ISI o�nic�,PO3:o �� 2,-; SJ 1•� �.• s�coz �na-qH-A,.a.:�.��J.^.tl(.. I hereby cerGfy Ne above statements are W e, coriecf and wmplete' (num6er arr� �street,-dty, �state,YlP coda��— U,..� : _ . :of ' _anl JNTIES':',�„ �P L_ €�z"��q?s�:� ` _��",Fni�r�"Y��'�.�'y. ;�e.�'v`'',.x,STANDARD;DEDUCTION�AL'L'OWANCE"�::��C;.y��'z°-"y'�'�.�,.?�',.;+'?c�.�y�s�r 20_Pay20_ Lesserof 1/2 Homestead veivaLOn a E35.OW S Signature of A�M�rta � Date signed