Homestead_SchmitsCLAIM FOR HOMESTEAD PROPERTY TAX
` " CREDIT/STANDARD DEDUCTION
� � � Slate Fwm 5473 (RS / 70-01)
��� Presaibed by �he Department of Local Govemment Finance
INSTRUCTIONS: See 2verse side !or filing insfructions.
FORM YEAR
- � A�- j , Hc�o� �
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ANK 2 3 z003
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I(We) a certiy that on Ihe.tstday-ofMarch, 20 �
�.�.._ _.. v...�.�1Y FUblw.—
I(W�upied as our principal place oi resid ce the following desaibed real pmperty for which a Homestead PropertySarCredit is hereby daimed
I(We) owned ❑ Are buying under conirad
� Have a benefidal interest in fhe enGty ihat is liable for ihe properry taxes on the property and that rnms the properry or is buying under a wntraU.
If buyug on conlroU. Fee Simple ownefs name
Recorders ofica where conUact is recorde0
County
Parcel number
Tamship
Legal tlescriDiion
7sing disUict (riry, rown, township)
Is Ihe
Recard number � Page
OrJ �- 6//, 3�%- ai I,J o-3-i6 /. Z 8" ( �Reai v�oero ❑ rowoae Homo �i.c. ��. �-n
H eny poNm of Ue resi0ential sW cNre w Ue land not anceedinp one (1) ave thet imme0iatety wrrounds ihat sW cture is used to produce income. desai6e ihe usa antl portbn
of the propeNy uUT¢eO to produce irrcome.
County
Twvnship
I hereby�certiry the above sWtements are We, coneG and complete.
Address (numberand 56eet, cify; atate, ZlPcode)
CouMy
Tavnship
������ �°-��="•`'�'�'�: "'�"-'k` +�7R TAX��� ASSESSEDVALUE aHOMESTEAD��-3Y�`` NONi2ES10ENTIAL�$ °
ASSESSOR 11SE ONLY � '� '� � '�-
��z�a° �c�'4�?"��.�n'����'"Y�:�YALUE_;,,."�^".r'"'ATa100%'OF.S.T�Vs.��'VALUE!'�- _...�-sri�r%V/iL.UE��..`-s��"'�'•°.c'-tL'
Land not exceeding 1(one) acre immediatety (� � ' �� �=?=y°��.,r-�?.�'' �"�
surrounding residential improvements. ,�_�zs� �x
,p -�an�� y.� .
Other iand (2) :;�-'.'-'r�`. �x���"`�-.Z-�
-,�:����-s
Tdal land (line 1 plus line 2) (g)
��� ��J:..���,� �
Dwelling (4) 'a -,� 1�,'y.�_'
�.at,;���`F-�.,t_,5, a�..�
Residentialimprovements �.�r:x,_���. }, _,K�^
Garege (5) � -'- a„ g i
?.l`, ?e•,: n'£�.re�fi?���.k+'�
y�. _���"*.i�t
Other improvements (6) �
„_r- �
TUaI improvements (line 4 through Irr�e 6) (7)
T[tal value Qine 3 phs line n (g�
I hereby ceAify the above is We, corted, and Signature o(Assessor �ate signea
complete.
Veilying action - SignaWre oflwtliror �ata signed
�•�K. � E. v3 ^'13'"Q` +dS 3�L�s:iETt f� .4 1 A �X� Y• ��•t�i'i4+
����a�-�.�r�:;�'�,-- �>f�.'sTnNOaRO;oeoucnoN�nuownr�ce�`�,���.f.�:m�a'�-��+����:�.�:�.�,��
• 20 Pay 20 _
Lesser of 1/2 Homestead g
Valuation or $6,000
SgnaWraofAuddw " Daresigned