HomeMy WebLinkAboutHomestead_Obryan4� rt� ; CLAIM FOR HOMESTEAD PROPERTY TAX
= CREDIT/STANDARD DEDUCTION
S / Sute Form 5473 (RS / 10-01 �
Prescribed �y the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side (or filing instrucfions.
� ��� ��'�� (�-�,� '� ,.a"��: *f`i'�x -- _:_. . _ . ..'CERTIFICA710N STATEMENT"-_ .
FORM I — YE� __ �
H�,o b
I(We) /r � 1 � certify�iai on�ie t d y f M r ,� 20�
I(We) occupied as ou principal place of residence Ihe following described real property for hich a Homesiead Property T� Credit is ere aimetl
❑ I(We) owned ❑ Are buying under contracl APR 1 9 2002
�-lave a benefidal interesl in the entity that is liable for the property taxes on the property and Ihat owns the �foperty or is buying iyider a contract.
If birying om m�trad, Fee Simple owners name
RecoNe/s office where conUaC is recorded
County Tamship
P r �^_ L Idescnption
{ �'1
�.I\./
if any porlion ot ihe resiCential sWClure or Ihe land not exceedi
of the wooerty utilized b produce inwme.
� , �i
CouNy I TuvnShip
I hereby ceAify the above statements are true, correct and wmplete.
Rewrd number � Page
Tacing distritt (ury, town, township)
�' Is Ne property in ques' :
� I propeRy ❑�bile Homn (I.G G7.7-7)
liately sunounds Ihat sWCture is used to protluce income, describe the use and portion
3
Couniy
� ���."'�w .�.�y'�'A"�°'�"r'�'� �"' �' > �� '�,� �'.'¢�. =�"TRUE.TAX ASSESSE� VALUE HOMESTEAD'� � � '�� NON�RESIDENTIAL` �f � ��
t��;�, tAaSSESSORUSEONLY.�;.syF � VALUE�' -:AT700%OFTN r� ."VALUEsrYC`� ��y�_"yVALUE -'�;;�'�'"''�'`'
�_++. rt�.�::a'�£ .z�?i'.-°"�`. ..ir .'sp.�� s.� �+�..�.._, x-.., ��'P.c_ - s�i:f�
Land not exceeding 1(one) acre immediately ��. K p�'w��., v.� �x -' ",: x s�':
:,
surtounding residential improvemenLs. (� � •{ .,,,yti."i=: �„ -,_r� _..�'+�"..: � i -
�� �'""ti`'�z i.�; u
Otherland (z) � - T,� �y _�
.. £ _,,z
Tdal land (line 1 plus line 2) (3�
�;..., r.�-�.; �u�.yszs��iy+ �'``
Dwelling (4) 'aa--z-�n 4 ���ar�z "'`��-�.�+�r?:;
Residentiai improvemenLs
y^�s+-.Z.qi...� r�y � s..ey,_,s�,
Gara e ���"� t - ��c�'
9 (5) �4t�s�>�:�'-`•'�"-�;,�%;(:r,..;�_�
> �i _ i' .�3i'y � � 3
Otherimprovemenis (6) i: T�. , �. .�,
.*�, :t:
Tctal improvements (line 4 through line 6) (7)
T�al value (line 3 plus line n (g�
I hereby certify U�e above is We, corted, and Siqnature of asseswr Da�e sgned
complete.
Verifyi�g adbn - Signature ofAutlitor Date signed
�*-_'X-`_-.4'�,'�'si^�.aa -.-��_�:PF �i...�,`x'�i���.' a•ST/WDARD:DEDUCTIONALLOWANCE .a'�'.s'•:�i.�a�y3:a"..•� -' ,�".�r�s�'a7'.��;:=5„��:
. 20 _ Pay 20 _
Lesser of 1/2 Homestead
Valuation or 56,000 5
SignaWre otlwditor Date signed