Homestead_May' CLAIM FOR HOMESTEAD FROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t Sqta Form 5a73 (R614-03)
' Presmbed by the Departmem of Locat Govemmenf Finance
INSTRUCTIONS: See reverse side !or filing instrvctions.
� FORM
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FT
YEAR
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I(We) , certify Nat on the tst day oLMarch, hY05
I(We) occupied es our prindpal pl of residence the �dlowing described real prope for which a Homestead Property T�c Cr ' is here'b`y�d�aiimed:
� I(VJe) owned ❑ Pre buying under contract � �+�
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Have a benefidal interest in Ne entiry that is liable for Ne property taxes on the property and that owns ihe property or�svuymgCi�3l�oAt�4t70R
If buying on contratt, Fee Simple awnefs name
Recordals oMCe where conVact Is recnded
Counry
Paui number
UU' 1-
Ir any poNon o+u
W Ne properry ut
Tavnship
e 18M rwt
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Record number Pepe
Tadng distrid (ciry, town,
� I Is Ne P�GertY in questian:
❑ Real pmperty ❑ MobOe Home (I.C. 6-1.7-n
(1) aae ihat immediatey surtounds ihat sWCture is used to produce income, desaibe Ne usa and porlion
�--_ �'G-/9�y-�`oo-oo�. D�o-a�S i
��`��$�"rj''A`�'�'F-��`k���?��r�b s�-°i'�TRUEiTAX� �� �ASSESSED VALUE aHOMESTEAD �+� NON RESIDENTIAL`� 4�
�� �Y�x�,��A�SBE�OR � E�ONLY � . � �..j ��q�VALUE�,.`y�� `?AT�100X�OF-TN .`r .'iVALUE �9.5 '±����.7� �?���.tVALUE`Y �`3 r �
Land not exceeding t (one) acre�immediatey ��� � � , . �.�ts�^ ����'a� r�z£ �'�;a �N
surrounding residential Improvemenis. ;; K�.._..,�,, „y,,. ; �; . :Ku_; _,'�,, ,, y �°±
Otherland � - r ��.:";}F � ..
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i. ai"v
Tc[al land (Ilne 1 plus llne 2) �3�
, r
Dweilin q :� i r�r.�w'.�,��3�rx£��.
Residentlal improvements or Mnually 9 � � r,�'.��` ��;u;:� p�' �"" ���` �„�;
Assessed Mobile / Manufacn�red Home Gara e �i'4 ' ' ���� '� � : b �
9
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(5) "y.'"..�-i...'^v: ��'„`��__�.«-n«'.�
O�pei improvements (6) -Y
'-�-�1 i a,,:
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Tatal improvements (line 4 through lirre 6) �7�
Tcial value (line 3 phs line n (8)
I hereby ceRify Ihe above is trve, cortect, and Signawre ofnssassor Dau sipned
wmplate.
Vaifying eCion - SlpnaNre aflwditw �ata siBneO
20 _ Pay 20 _
Lesser of 12 Homestead
Valuation w 535,000
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