Homestead_SimpsonCLAIMI FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
StaM Farm 5173 (R6l M3)
Re�vibed M tM Departmmt d Lortl CwvemmeM Finaxe
INS7RUCTIONS: See rat�ts s4b k7r R,fip it56ut0iyta
i��y
� FORM YEAR
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I(We) certify that rn�-thed'st�day of March, 20
I(We) occupied as our principal place of residence lhe following described re property for which a Home�tead Prope� 7ac Cre�dit is hereby daimed:
�u�� ..vJn � Y AUDITOR
❑ I(We) owned ❑ Are buying under contract
,' Have a benefidal interest in fhe enfity that is liable for the property taxes on Ne property and that owns the property or is buying under a wnVaU.
11 buying on contrad, Fee Simple ownefs name
Recordefs ofice where mnVacl is recorded
County
I( eny
of ihe
TamsND
sWCture w Me Wnd not eaceeding one (t) aae
ice income.
ea�;n {ary, rown.
Is Ue
immediately �urf�unds
�%�C�
� �'�-i 9-a� =dcb-�a . o s�� ��
Rewrd number
❑ Mobila Homo
Pa9e
used to produce income. describe Ne use antl portion
� a "'�"����`�'�'���'�'�''� +`�'TRUE TAXy `� M ASSESSED�VALUE HOMESTEADT� �. �y�,,NON-RE5IDENTIA��
��� �p,�.�ASSESSOR�USEONLY�y'f�{" �y�1�y�UE�.k ATt00k.OFTTY �e VALUE �}' -i�VALUE�s��
��sry.6 �*`a�3.-°.a<.4.Ct5'�P��oe...3±�C���� �� e s^. ,r.3..�; .� nH...�?: �3�.'.$.e. �.a:..,-
Land not exceeding 1(one) acre immediatey r? � q`5�,�x�"���-'�r`��p�^'�
surtounding residen8al improvemenis. �� � �" z'={r'y��-�°�`. �.�.'4..' �
-...�'`i4.'=�..e... ..:E..�'dat--,. . a:'�..
Otherland �'��a`.`�����'� .
(2) ,t's�A� .
v-�:.�.�3.+'".a.. ' -
Tdal land (line 7 plus line 2) �g) ,
..-�.} r. =.rfs�;�b��� � .�,�
Dwellin � "' �� n`" ���°g7r� '� �
� 9 (4) ��r�'�iLrd. �-�a�-.>'�"dY��".L."4i'.`�r`:+b�
Residentel Improvements or MnuaOy
A� Moh9e I ManufecNred Homa Garage (5� - ���"�' :,t x�"'x2°x� %
" `�`�k�a '2yrT �u
� ��::��i
Other improvements (6) � i� �'� % r �` �
�??�"�3�
Tdal improvemenfs (line 4 through line 6) (�)
Total value (line 3 phs line n (g)
I hereby ceAify �he above is We, corred, and Signature otASSeswr Date signed
complele.
Vaifyirg action - SignaWre oflwdiWr Date signed