Homestead_RiggsCLAIM FOR HOMESTEAD PROPERTY TAX
� CREDIT/STANDARD DEDUCTION
♦ .� State Fwm Sa73 (R6 / 4-03)
Prescnbed by lhe Departmenl ol Local Govemment Financ_
INSTRUCTIONS: See revcisc sidc !oi /ilinq insbur.6nns.
��e) ` thatQfrt4lt�"Ast day �/ M'S�jt� 20
I(VJe) ccupied as our principal place of residence the following described real p p rty for which a HomesteaGtPBromA�7�IJBF�i}it 45�re6y Gaimed:
Svr
(We) owned ❑ Are buying under wntracl
Have a benefidal interest in the entlly that is liable for the properry taxes on the property and that owns the property or is buying under a contract.
FORM �1 YEAR
c1 �
�
FFe o a 2005 .
certify
�
If buying on contract, Fee Simple ownets name
Recordefs afice where contraq is recorded
Remrd number Page
��•'4 ]+u)�..:.� � :_ �:..[)�.' ^!Y.+%�.Yr="' _ " _ _ �.... ... .__ ._.:�_. �.._.
_<PROPERTYbESCRIPTION?!�- � � � -�
�=z-� . f . - : � . .. . .
�nry Tamship. . Tsing tlislriU (tity, town, townshiPl
Par I um r_ � Legal descn0�ion Is Ne prope in estion:
Real praOenY ❑ Mobile Homo (I.G. 67J-7)
If any portion ol the residentlal sVUCWre w tha land not e>ceetling one (1) acre that immediately wrtounds �hat sWCture is used to praduce incame, desuibe the use antl portion
ol the property utilized to produce inwme.
Counly
I hereby certify the above statements are We, correct and wmpiete.
Add2ss (number and stree(, ury, sfa(e, ZlPcode)
- �oa./�9- ���s
County
tlai � ��
1
To.vnship
0
�
`,�.a,�;-��1�`�' ASSESSORUSEONLY.... � .�- � TRUETAX ASSESSEDVALUE 'HOMESTEAD NON-RES�DENTIAL�
:,nr k �.� _�..s.='+ - � � VNL.UE �AT700%OF.TTV- VALUE �: VACUE;� "
Land not exceeding 7(one) acre immediately -+=;r '*' � -`�i'.
surroundingresitlentialimprovemenis. (�) . . � .. ��
Otherland (2)
TUaI land (line 7 plus line 2) (3) I
Dwelling (4) _ -
Residential impmvements or Annually t. �
Assessed Mobile I Manufactured Home Garage (5) _ -- �
Other improvements (6)
Tdal improvements (line 4 fhrough line 6) (7? I I
Ttial value (line 3 phs line 7) (g� I
I hereby certi(y Ihe above is Irue, cortect, and Signawre o( nssessor Dare signea
camplete.
Veriying action - Signature oflwtlimr Oa�e signed