HomeMy WebLinkAboutHomestead_Pohl (8)� CLAIM FOR HOMESTEAD PROPERTY TAX
° CREDIT/STANDARD DEDUCTION
t State Fwm 5473 (R61 d-03)
' Presaibed 6y Na Depar4nent of Local Govemment Finance
INSTRUCTIONS: See ieverse side for filing instnutions.
FORM YEAR
Hc�o �
'P"v- 'r.. -iy_ . r.�.>ac- '+..:n..�._ _ �..�. pS{:tKI1F,IGATlONSTATEMENT. / � :s: :
I(We) certity that on the 1 st day oi March, 20_
I(We) occupied as our prindpai p of residence Ne following described real property for which a Homestead Property T�c Credit is hereby daimed:
�I(We) owned ❑ Are buying under contrea
Have e benafidal interest in the entity Nat is liable for the property texes on the proparty and that owns Ne property or is buying under a conVact.
f buying on conVact, Fee Simple owners nama
Recorder's ofice where cantraa is recorded
Counry
number
If any portion of the residential struUUre w
of the pnperty utlllzed W produce incoma.
�
Tamship
nat exceeding ona (1)
0
.
.�uniiwcr.newnutuE';;.- - � a�..a -
� s.
Rewrd numbar PeBe
tROPERT,Y;DESCRIPTION�:�=„' - °`�` :'. -..�.. �_. �:''.'...
Tmin Istrict (crty, tOwn, township) `�
Is Ihe property in pu85Uon:
� ,� eal proPerty ' ❑ Moblle Homa (I.C. b7.7-7)
aae Nal�im\ iately wrtwntls Ihet sWaure is used lo produce inwme, describa the usa an0 poNon
0�9-0��.
�ZcLI.����`Y'y+�'`Ly � «S " . .� :.. ....
�- '�''��."'-s�. -.�::"+-.,:��?`�BROP,ERTY.OWNED�;BY,CUUMANT.IN'OTHER�COUNTIE$ � �:- ° ; wT.-,.�.. � -`. '�- :��, �.'� "�
Counry Twvnship County Tavnahip
I hereby certify the above statements are We, cortect and complete. Signature ot cleimant
ress (number and sueat, city, state, ZlPCOde)
2t�;:x ��r � �����' �Y""�5�..�''�i��}�""{� �TRUETAX� �'i ASSESSEDNA[UE HOMESTEAD . �� '�. ti NON�RESIDENTIAL
:,r�x��et�..��.ASSE�S�S�E'�O�N;L��`t,3..�axr���VALUE'?' � �AT�100XOF�TTV +..r�VALUE}x,':::•.r�z�,?-;,�VALUE�.���t` .
Land not ezceeding 1(one) acre immediatety '.�F � i ��.� -` a a-4
surtoundingresidentialimprovements. (�� _ ���:;` � , `t-" ; ��
F_ `
Other land (p� � f' � =+; � �- � ,
-�
TUaI land (line 1 plus Ifne 2) (g)
Dweiling (4) � � . rj . -�� 4�.--_i' s . . ..
Rasidential improvements orMnuapy .-..ri�;:! -,• .-�: :'�
Assessed Mobile / Manufaccured Home ?. � � :r, � �-;;;; �
Garage �5� :. ��"- ..
hliH � � I
�
O�bel improvements (6 _ : '� ° - �� � �'�
) �. ��.-a,::-
T�al (mprovements (line 4 through lirre 6) (7�
Tatal value (line 3 phs line n �g�
I hereby certify the above is We, correct, and � signawre otnssessor � Dau sipned
complete. .
Veilyiny ecUon - Signawra aflwditor Date ugned
�ka,��'i's �L�'f"s� �.;.w,,,}:i_.�.�..�� �,�,� �:aST/WDARD:�EDUCTION'ALLOWANCE �;:. . Y.. .1'r• . .
, ,. .., . ...� �. �
. ._ . _ . . _. _ _. ...:� . ._ �•: . _ .. . . .., , . ,
20_Pay20_
lesser of 12 Homestead
Valuation or 535,000 - g
SlpnatureofNiditor Dat ignedC a
�'V —�
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