HomeMy WebLinkAboutHomestead_Sorgius; CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� � S�a�e Form 547J (R6 / 403)
�`
FORM YEAR
HC10
Prescnbed by the Departmem ot Local Govemment Financ: �����
INSTRUCTIONS: See �evcrsc side !oi lilin�� Insliur.hou:;.
- �� � � ' ' '� �+%�' ' ` -'� -� CERTIFICATION STAlEMENT'�� �� - �� - � ^
. t 3 �. t :'��� 1�:'�'E �-t . . � . ... . - .
I(We) he 1st day of March, 20_
I(We) ied as our principal place of residence lhe follow uibed real propeRy for which a Homestead Propeyrfy Tac Crp�1 s hereby daimed:
Q�( �
❑ I(VJ owned ❑!ve buying under contracl� � �'
� Have a benefidal interest in the eniiTy that is liable for the property taxes on lhe pmperty and that owns tliZ�p�opertyor i��Ti�rI�LRtlBP3 contrac[.
I( buyinq on contraU, Fee Simple ownefs name
whara conVad is recortled
Counry
Tavnship
ESCRIP,TION�:= � - •� ••- �
Taing tlistrict (ciry, Iawn. townshiP)
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Record number Page
Parcel pu `ber ���r�� I Legal tlescnplion Is �he pmpeny in ques�ion:
� � `� "V�J ❑ Real DroOertY ❑ Mobile Homo (/.C. 67.1-7)
If any portion ol the resiCenlial sWClure w the WnE not exceeding one (1 � acre that immediately sunountls lhal swcture is used to D��uce income, describe tha use and portion
ol the property utilizeE to produce inwme.
- �3 //= �ao- Qo�..Da� �
a,�r.';;.'.`�o'�'� '� �.-�:-'"` >� ---_`� .sP.ROPERTKOWNED�BYCLAIMANTIN.OTHER`COUNTIES'� . � '.��' -+� - . ` .. .
.� _
County Tv.vnship Counly Taons�ip
I hereby certi(y lhe above statements are true, coved and complete. Signa ur ( tlaimant _
Adtlr s(n a streef, ', stale„ZIP corjej
57
,`p�� �$� � i"'� �ASSESSOR USE ONLY �� _ . � : TRUE TAX � ASSESSED VALUE �HOMESTEAD ` NON-RESIDENTIAC
.,�,x�y.,� �,�,��-.. F.t t -,,;_�z-;. . - VALUE - AT100%OF�.TTV.. 'VALUE � v:''�-VALUEt �
Land not exceeding 1 (one) acre immediately . . - � - . - .
surroundingresidentialimprovements. (�) . . '-� . � .
Otherland (Z) � - � .
TUaI land (line 7 pfus line 2) �3)
Dwelling (4) , ,�� � :..:-��.- ��� .. ���
Residen6al impmvements or Mnually :.: ': -s1��,;`�'-�tir,.�:�>x�..;, +.:,: .: i
Assassed Mobile! Manufac[urad Home Garege (5) t'�~ �' -
Other improvements (6)
TUaI improvements Qine 4 fhrough line 6) (7)
Tcial value (line 3 phs line � (g�
I hereby certify Ihe above is W e, corteG, and Sgnawre of nsseswr Date signetl
complete.
Vetitying acl'an - Signature oflwditor Dale si9ned
. .. _ ->' •. y, : � : :
20_Pay20_
Lesser oi V2 Homestead
vruauon or 535.000
�
SgnaWre of Audilor ' �� 'n n n �� n . I Dale