Homestead_TalleyCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Fpm 5473 (R6 / 403)
PrescriCW by Ne Deparbnent of Local Govemment Finance
wsrnucnolJS: see reva,se s;de lo, r,r;ny;,uhucr;ons.
R YEAR -
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APR 2 1 2006
� �e) °�" certiry t6�eS�Af�QA�d�JNf k�6i@h?48
I(We occupied as our principal place of residence the followi escnbed real prope ' a Homestead Property Tac Credit is hereby daimed:
e) owned ❑ Are buying under contract
Have a beneficial interest in the enfity that is liable for the property taxes on ihe property and Ihat owns the property or is buying under a contraU.
If Euy'ug on conVaq, Fee Simple owner'S name
Recordels olfice vrhere conUaq is recorAed
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County To.mship
Tacing dislrict (city, tawn,
Record number � Page
Pa�� u�berO'7Q �/ � �¢� descriptio� �� � // Is the Property in question:
vc G ii � �� �
_t1tL O �- � ( eal p operty ❑ MoMle Homo (I C 67 1 7)
N any portion ol Ne res�den�al sWCtura w the land not exceeding one (1) acre that immediately sunounds Ihat sWUure is usetl to produce income, desuibe the use antl portion
ot Ihe property ulilized to produce incoma. �
aG�
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�� ��E ASSESSOR 11SE ONLY�'� ��, ���"' ,,�3+TRUE TAX� � ASSESSED'�VALUE HOMESTEAD � i cr�r NON�RESIDENTIAL �i�
'�'�� „�„i,,;,...K y ,..'� 3, f � _, c_�.�}s�,� ��,�.VALUE;� z ; . � /1T t00�.OFjTN� �iV/1LUE� � '�'� T VALUE z*�;.
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Land not exceeding 1(one) acre immedialely ;�+�� ����`���t
surtounding residential improvemenls. (� � 't ��{,W��„�r�e� ��d�,l }�
Other land �Z) s�`�`�-���`� r{i �
...,a': __.�-�a
Tofal land (line 1 pfusline 2) (3�
�_� H'�:,.
Dwelling (4) ���.��`'���..�� �.�
Residentlai improvements or Mnually ry ��`����
9 (5) ����"; ��` r � ��s .r;
Assessed Mobile / ManufacYUfed Home Gara e
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...�,_-y �,��=-:,,r3=:
Other improvements (g) �=�r ' '•°�' -i3
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-�_-�.-..`G. "�a aw: �
Total improvemenis (line 4 fhrough line 6) (�)
Tdal value pine 3 plus line n (g)
I hereby ceRify �he above is W e, correG, and Signature of Assessor Date signed
complele.
Vrrifyi� actbn - Signature oflwEitor Date sgned
�s°'v`��a�sa'i4`"�'ia',' ��T:sx%,`.:3:o�'t7v"�y-4�R'-^.�?'���7�STANDAR�'.DEDUCTIONALCOWANCE �`�F�i.'a"'id?::��'�-�'':}:.4�F°'.t��.'�+`v�w�r�'..�""��":�:'.:
20 _ Pay 20 _
Le>ser ot tl2 Homestead
vavauon w E35.000 5
SgnaWre of Auditw � Date signed
lr1 w �