HomeMy WebLinkAboutHomestead_DeenCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
Stete Form 5473 (R6 / 4-03)
PresaiheE by Ne Departrnent at Local Gavemment Finance
INSTRUCT10N5: See /everse side (or filirg inshvctions.
�_`.,�3.�" r„�u z•-'�'�"�J; ""`..? �a'�'+�L' �=�:.l�ti-.:k� �"�. �`=CERTIFICATION STAlEMENT:;.: .
� N`'e) �j_C ,�� � Y ll � �v
I�(VJe) occupied as our principal place of reside�ce the following escribed real property for which
FORM � YEAR
� "
certify that on tt(e 9"sf�U2y�� �ch, 20_
�.stead Pr��d����.�e��lqlp�pied:
�(We) owned ❑ Ne buying under wniract
Have a benefidal interest in ihe entiry Nat is liable for the property taxes on Ihe property and that owns ihe property or is buying under a wntracl.
I( buying rn conUad, Fee Simple ownefs name
Recorders ofice where conVacl is recorded
Record number � Page
Counry Tavnshjp T�ng d' ritl (rity, town, township)
Parcel nu ber Legal descnption Is the pmye in question:
�
� 0 O � ' � I proDerry ❑ Mobile Momo p.C. 67.7-7)
I( any poAian o( Ne resiCenllal sWCNre w the Wnd not exceeding one (1 j acra thal immetliatety surrounds Nat s ure is usetl to produce income, desvi6e fhe use and pwl'an
of Ihe properry utllized tn produce income.
�""°`�•+"� '`� - ' `� "��- �����'¢�"TRUEvTAX�� ASSESSEDVALUE r HOMESTEAD�'�;�=r� NON-RESIDENTIAL���a�y�+
�?�� �ASSESSOR I1SE ONLY � . �-tg�� $�k'$����Eww V pT•100°� OF'T7V - {� �VALUE � �'; 'VALUE'� �([
N f.. 5�., `Y ,�c�'SreYt Y�3.� � '�i] �..�x.. €.° a�T.Py��.. .,�-�fi. F �s4�.a?� .+,. ..R•Y:� £K
Land not exceeding 7(one) acre immediatety "" j•"` ��,.�=��' trr?
surrounding residential improvements. (�� �-+-�.3��`:��y#F�T�4' .�-,�j
....3..,..e� .�-..�3�.w = L-.�.=
Otherland (p) ��� ��'�
'r'�a r �
���,. Y.�Ek�
Total land (line 7 plus line 2) �3�
�;k'� �jk���147� l=3-_+�.���-,:�t�
Dweliing (4) ��,G�--• �����
�Residentiel improvemants or Mnually ��,
Assessed Mobile / Manufxtured Hmre Garage (5� :��.}�� �?�.y���+�
�$+,'k„�'S�`-,l"'rh wi.- t..._..�
Other improvements (g) i �° .. ���s
�tiiY.-��r,i� '�'
Tdal improvemenis (line 4 fhrough line 6) (�)
Tdal value (line 3 phs line n (g)
I hereby certify fhe above is We, coneU, and SignaWre o(Assessor Date signed
complete.
Veritying aclbn - SignaNre of fwditor Date sgned
20 _ Pay 20 _
Lesser of v2 Homestead
vaivauon w 535.000
S
Date