HomeMy WebLinkAboutHomestead_Goldman;� CLAIM FOR HOMESTEAD PROPERTY iAX �,,n � FORM YEAR
CREDIT/STANDARD DEDUCTION YV\ HC10 �
♦ � State Porm 5473 (R6 / 403j I'
Prescnbed by ihe Department of Local Govemmenl Finance �����
INSTRUCTIONS: See revasc side (or 7ilinq insliur,6rnis.
.� �.�-i ... _ -- : - .:-. .-,=�� '� — '� - CER IC N STA ENT". . .. _ ., . .
I(We) c i t e tst day of March, 20_
I(We) occupied as our pnncipal place of residenc the foliowing descnbe eal property (or which a Homestead Propertyi�c,�redit ishgleby daimed:
❑ I(We) owned ❑ Are buying under contract p�/a� ,(Si,�a�
'i Have a bene5dai interest in the enti ihat is liable tor the ro e taxes on the ro ert and that owns the roGeBSONsr O �N �� p(/I'f1IT R
�Y P P rtY P P Y P P Y bUY 9 deT3toRtYact.
If buying om m�trau, Fee Simple owners name
Remrders office where contracl is rewrde0
Tavnship
c�=�vo33 -a� � --��
If any ponion ot tha resiEential swaure w Ne land not e
of the propeny uWized to protluce income.
��
�.3`;'"�-<.�i....�:� .-c =� . � - ' � F
County Township
RECORDEO�?'
Record number � Page
'���`PROPERTYOESCRIP.TION'"%, � • ' � � -�� �"r""'-- -- �
Ta�ing tlislritl (tify, fown, t nchip
Is Ne property in Ques n:
ea1 ro0erty ❑ Mobila Homo (I.C. 67.f-7) '
one (1) acre that immetliatety sunounds that st c is usetl to protluce income, desuibe the use antl poNOn
� iivi-un�iii."�'�_
I hereby ceNfy Ihe above statements are W e, wrted and wmplete.
A�ss ( antl strre�, ury, stafe, ZIP code)
�� I P�c b5—� i Pr� �
Counly
�; dik'+,^"F
iwvnship
y -*,�y ; i".ASSESSOR-USE ON Y . , - �� ., TRUE TAX ASSESSED VALUE -� ��HOMESTEAD ` - NON-RESIDENTIAL,
-;:nir . C.:....... ...�:=s..=.---.. �.-- ` ' VALUE �AT100%OFTN;� :' �VALUE" '.s-. � �� . ;:_.VALUEi. �-....
Land not exceeding 1(one) acre immediatety ,, -�":"""= "_
suvoundingresidenfialimprovementa (�� � .`T''`'��-.. �
Otherland (p) - ' ._ -
Tcial land (line 1 plus line 2) (3� '
_ . .�� _, . . .
Dwelling (a) ; t.,:— ' . .t -.
ResidentlelimprovemanLSOrMnually �"'��"�''""-`�"�:"'"�`" '
Assessed Mobile/MamfiaGUred Home �:ic;^;: �=i.;�r:>�.i.'.:,,` _.. _-
Garage (5) — ,
Other improvements (6) I
Total impmvemenGS Qine 4 lhrough line 6) (7)
Tttal value (line 3 plus line n (g�
I hereby certify the above is lrue, cortect, and Signature ot Asseswr Date signed
wmplete.
Vmfying acbon - Signature oflw0itor Date signed
— _ -�STANDARDDEOUCTIONALLOWANCE"�.�� �� ' � '. __..-.. . �
20_Pay20_
Lesser of 1/2 Homestead
va�uaUOn or 535.000
Signatura ol
E