Homestead_RobertsCLAIAA FOR HOMESTEAD PROPERTY TAX FORM �4I� YEAR
CREDIT/STANDARD DEDUCTION Hcto
State Fortn 5113 (R614-03)
Ra�aibed Cy Ne Depmtront d Locel Gmromrtront Fownce -�--�
INS7RUCT10NS See ie�erss t!� 1{7rl8tp ns6yctiona p,� �
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a=�:' _�-�.x"a..'�,:;�ti� s.'�"s�''�'Fw'-:,�''�t--�'����CERTIFICATION�STAlEMENT.r`r� +�,<?- ,: �.. �.r -��: : ��?� .-
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, M,e� �� � Q 6 2005
certi(y thal on the 1sl day of March, 20
I(We) occupied as our principal place of re d nce the following described real property for which a Homestead Property T�c�edit is hereby daimed:
❑ I(VJe) owned ❑ Are buyirg under contract (�IlO� � '
� Have a benefidal interest in the entity ihat is liable for ihe property taxes on the property and that o�n�Ne prCpeh�i�ris �i�Uhder a conVaU.
1f buying on conVact, Fee Simple owners name
Recoidefs ofice whera conUaIX is
Record number � Page
Counry Tamslvp T�ting daVict (dry, fown, townshiP)
^ r (� ,L'�/� 2 q�C� perry in question:
u r�O( l -1 •��l/ '�,'8$ �J � V Ql' �] Reai DroPertY ❑ MoWe Homo (I.C. 67.1-n
It any ponion o/ Ne resitlantlal sW cWre ar tha land nat ezceeding one (1 J aae that immediatety wrtounds Nat sW Gure is used b produm inmme, tlescribe the use antl portion
of the property utilae0 t0 produce income.
�'''s..-����'��v '�'��u'atl��'.`'ei54't��r`�,�,-�STANtiARU:OEDUCTION`ALLOVIIAMCE �c;'r�,�.�.1'''x}`�:."���'���-,'.`m�` `�` ���' .
.. _ ._ ... . x. u ?e,i•"�,+�'�..` � .va�S'+�.`w
20 _ Pay 20 _
Lesser of 1/2 Homestead $
VHUebOn a 535.000
Signature of Pamitw ' Date signetl