Homestead_Chamberlain (5)��n CLAIM FOR HOMESTEAD PROPERTY TAX . ' FORM �
� ' � CREDIT/STANDARD DEDUCTION HCio M ��.
State Form 5I73 (R4 / &00)
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INS7RUCTIONS: See 2verse side for filing insWctions.
Counry Township Tacing disVict c' fown, fowriship)
r ���0 � ^ Legal descripUon
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It arry portion ot Ne resiEential sWCture w lhe Wnd not exceetling one (t) acre that immetlWtey surtounes that structure is used to produce income, deuribe the use antl portion
�of Ne property uGlizeA to produce inmme. .
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'-a3o6-o�/. �a/-a�S �. .
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I hereby certify the above statements are We, arred and compiete.
`ress (numberpDd�tree( city, state, ZlPCade)
Land not exceeding 1(one) acre immediatety
surrounding residential improvements.
Oiherland
Tctal land (Gne 1 plus line 2)
Dwelling
Residential improvements
Garege
Other improvements
Total improvements (line 4 through line �
Tctal value (line 3 phs line �
I hereby certify Ne above is We, correG, and
complete.
Verirying aUion - Siqnature o(lwtlitor
(�1
(2)
(3)
(4)
(5)
(6)
�1
�8)
- ITavnship
�e ol Gaiman�/A/�-'/��r�-�
"'�"`� 4�/ .
�� ��,�Z
iSEDyVALUE' �HOMESTEAD� ��.��=��
i0��.�i�� !`,:��31/AL. U,�':� 5 �. ...
+ � c+'.�:-"�,.M�.
Date signed
Date signed