Homestead_PolenCLAIM FOR HOMESTEAO PROPERTY TAX
CREDIT/STANDARD DEDUCTION
State Farm 5173 (R6 / 4-03)
PnsaiDed M tlro DeparV�nt d Local Govanrtient Fina�e
� �NSrnucnoNS: s� ��. ma. a�:�o.
�
FO�tM YEAR
�i'! �
HC10 k-J �
�t C ' �
., - .'�.�
NOV 2 2 2005
i M'e) � %Cl�(�/ �' ���'0�. / `Jo�!/i� �°� � ���
certify that on the �ts�t� nd1Tay.of��� ch� 20_
I(We) occupied as our principal place ot residence the following described real property for which a Homestead@F6�r�¢Tmtt,'tE�dii is hereby daimed:
❑ I(We) owned ❑ Are buying under contracl
� Have a benefidal interest in the entity thal is liable (or ihe property taxes o� ihe property and ihat owns lhe property or is buying under a conVaU.
11 buying on coniraG. Fee Simple ownefs name
Recordels ofice whare coniracl is remrded
�..'�_�;`:�� �.�-��"�`n�'�
CounTy �/i .. Tamship
CCI(�; �OWII,
rar i w r L g e Aptio Is the
o - o�8�a-oo �` s� g-� -�o
If any portion of Ne resiEenUal strudure w Me land nW exceetling one (1) aae Nat immedaley rtounCs
ol ihe propery uulizetl b produce i�ome. ��/�%
./
- / y- UO ' oJUU �
�zi�`�.��'�E' PROPERTY;OII
Toxnship
I hereby cerUfy ihe above sta�emenls are W e, wrred and compieta.
and sbeet, city, slate, ZIP cade)
County
��
Record number � Page
al Droperty ❑ Mobile Homo (I.C. 6/.7-�
is used b produce inoome, desaiba Ne use and portion
Twvnship
���'��ASSESSORU�S�NLYT`�r��3-s������UETAXS�'��g�SSESSEDVALUE�HOMESTEAD�� �.�a RESIDE'��L��h
�--�;��y_w�,�:�r ij"�"'�t�,�'�"� �w�VALUE�.-y �` _AT 700%.AF'TN� �� VALUE� �, �'A,�'�VALUE �^
Land nol exceeding 1(one) acre immediatey '� t^' �`S, y?��'�`��
suvoundin residentialim rovemenLs. (�) M�i���"Lb ' �
9 P ,.,_ y: z�,�i�9X�'2`,'�'ty"���'
A �=
Other land (Z� a�' �-. �,�,`�sy�
��y �
Total land (line 1 plus line 2) �3�
rs•� �r r• �_:-
-}• 3a �5� -��
Dwelling (4) r� � ti �` r-:�n����.
�Residential fmprovemenh w MnuaOy o..�-wt.- ': t:�r.s>;vy�t_�".��t•�:
Asswed MohOe ! Manufa�red Horrb �� �� � -F ,: "���'� -"y;;vm+� -.,
Garage �5� K� t t� �
`s`"�:`�'`_- ""- 7i
Other improvements (g) ��� -:'.-���-��p��,�h�
.=�a�-_ _ ,,- m SG u'
Tdal improvemenfs (line 4 fhrough line 6) (��
�I value (line 3 plus line n (g�
I hereby tertify fhe above is We, coRed, and Signature otnsseuor Date signed
complete.
Ve�i(ying action - SignaNre otlwdiWr Date signed
$�'?���`'�v,t���it�•�.,�>��;STANDARU:OEDUCTIONALI:OWAl10E�..,�`"��N'"�•.=�,y��-z'�'���+-'���`�:»� a
20_Pay20_
Lesser d 1r2 Homestead
vawabon a 535.000 �'
Signatura oflwditor ' Date signed