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�t\ CLAIM FOR HOMESTEAD PROPERTY;iAX. �/ d FoRM YEaR
" CREDIT/STANDARD DEDUCTION' ' ' ' '=�'/C � �, I'r HCio �
�S� Stsle Furm St73 (Rfi / 4-03) _ '
Prescribed by the Department ol Local Govemment Finano_ •• �� ���
INSTRUCTIUNS: See reversu Side /or.liGnq ir;�Uucfinns '' .
/"•';'11r;.3-.= ..iic�� .¢:::?' -::y�.,'%':.:,�CERTIFICAlI NS MENTr� ;�y-i::.' �:a, :,..���
�(We) � � that on the 1st day �o�f M�jr , 20
I(We) occupied as our principal place of residence the following scribed real property for wh� a Homestead Pmperty ��re�t i6' h�tE� daimed:
❑ I(We) owned ❑ Are buying under conlracl '
' Have a benefidal interesl in ihe entity that is liabie for Ihe property taxes on the property and that owns the property or ��y( �ontraU.
�
SON C
r�f.'�.� .� �3vyr;°�--;'3� _ -s�' ...�'v`",+�`;�.4. Tz..ae ,. L?-,r-�- . �^:�: CONTRACT'RECORDED:{y : r � . _ . ' . �. � . "_ �
II huying om m�Vaa, Fee Simpte ownefs name
Remrtlers office where conVaU is recorded
Rewrd number I Page
t:';..;.�a� _ i'%�'z':.. ... "
Cou�ty TavnShip � Taing district (ciry, town, to nshi
�
Parc�p�)n�u(yn, �7` �y� Legal Ae p�ion � Is t�e prope in qu ion:
t/ �/�'_Da.l_/ J LlJ ���� }% �� p . ¢al property ❑ Mabila Homo (l.C. 6f. f-7)
it any ponion ot Ine resitlentlal s'vucture or the land not eaceeding ona (t) acre t��a mmediately sunounds ihat s cture is used to produce income, describe ihe use antl portion
of Ihe properry utilizetl tn produce income. �
i'� ��a� '
+_:'3.r ' �f��4�?'i zt-'x d�:�si, .�.7't�'k�=�._PROFERTY.OWNED'�BYCLAIMANTINOTHER`COUNTIES>,.�?".'w-:-j{ bj .��Y�',�����.:. �, •_:, = #+r,:.`-?.•�
County Township � �� Counry Tavnship
I hereby certify the abova statements are true, cortect and complete. Signature ol daimant
-�dress (number mrd stroet. c�ty, state, ZlPCOde)
* +y���$.�A,S�ESSOR $�ONLY�y���uj..�-s�, �.z�?VALUE � ATE OYeOF"T7Yse �i;VALUE D� M��N� VAI.UEN�'� � ?s
Land not exceeding 1(one) acre immediately � i k' � �,��'�''�1`.k."� �r�?.°
surrounding residential improvements. (�� + ,x�`''�',?�,�.��4� � .�_` -��1�
Oiher land � (p� . -�`,��t�- .�-'a� - - —
_<,- ,-.la&-..s:.. . .. .
"'a�n.: -.n..,:,r:�.,
Tdal land (line 1 plus line 2) � (g�
9 �4� • .-1 S�'SYF�/VJ y��S. f
Resitlenliel imprevements orMnua�y �ellin +� �„fh � t{,� �� j �,�,� y� ��;�
Pssessed Mobile! Manutaclured Home ' kr�'A +i K��"�- ��r �=.
Garage (5) :t .�ys K ,t_, �
_ .c �•c..,_. _ i i: �, . : -d�...-: ;
Otherim rovemenis ' .'`i}�'§' �"
P . (6) ::a���ri:.��,R'
- 1.�RYyc£a::.
Tdai improvements (line 4 through line 6) (7�
Tdal value (line 3 phs line n (g�
I hereby certify fhe above is We, corrett, and Signamre ofnsseswr Date signed
wmplete.
Verityingaction-Signatureoflwditor � Dalesgned