HomeMy WebLinkAboutHomestead_Amick� . ' CLAIM�FOR HOMESTEAD FROPERTY TAX
CREDITISTANDARD DEDUCTION
t Siata Fwm 5073 (R6 / 4-03)
� Prescribad by ihe DepaRment of Local Govemmmt Finance
� INSTRUCTIONS: See reverse side lor filing inshuUions.
�
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FORAiI
HC10
YEAR
I(We) , certify Nat on the 1 st day o4March, 20_
I(We) occupi ur prindpal place of residence the fdlowing described real properry for which a Homestead Property T�c Credit is hereby daimed:
I(We) ❑ Pre buying urWer contract
Have a benefidal interest in Ne enlity that is liable for Ne properry texes on ihe properry and Nat owns Ne property or is buying under a conVact.
I( bvying m co�ect, Fce 54nple owners name
Reco(ders oRke where conVaC Is rawrded
Counry
Tamship
S/✓(c ' C.L J[I O OC �UC/ I l
It any pation of Me rasidenUal structure w Me
d Me property utllized to yotluce income.
one (1) eae thet
Record number � Papa
rown,
�s Ne poperty in uesllon:�
(� Real property ❑ Moblle Home (I.C. Si. f-7)
wrmuntls Nat s cture is used lo D�duce income, describe Na use an0 portian
�*:W3"stt,�`..'P,S��`Z,�*e�-FY._n'sI'z,+a?'k-„-`�.:i?PROPERT.Y.•OWNED'BY,CLFUMANT�,�H`OTFiER:COUNTIESx'-'�2 _r-,--�._-.-�a•,=�,.�i��,#.r �:'`=;'.:='s;-
County Toxnship County Tv.vnshlp
I hereby cerOfy the above statements ere We, correct and complete. Signatu�e oi cieimant
ress (number and sUeet, ciry; stafe, ZIP code)
�
���� �� A E SOR U E;ONL 4}- �� y�� ���UE S��[ AT 1 OX OF TN� 4� �VAL E�D'�; �"��NON�RESIDE�TIAL� q{� "_
'�.'�_�€�.�8-a'�.YH.._�Si.[.i_'t».rr�...'..�i.. .�� a _ ,-,�...t _ '�3-,�i;.,a. �,.�VALUE}.�e-�" �'�i
Landnotexceedingl(one)arreimmediatery �'� $;'�.�"�"'sy�r���� ���' ��#y
surrounding residantial improvements. r�,�s,,.�_,�x ti�v .-�; G�„ ��,
, `�
Other land �y� `�' ' :.,.,�' � _
Tatal land (Itne 1 plus line 2) �g�
y. +t. l Y-Y wv� .'�a� ; 3t�i.Y' �£!
Residen6al improvemenLS or Annualty �����g (4� ";::.- � �"` ��`i �•i , �. �-�
Assessed Mobfle / Manufacwred Hwne .:x n r�� ',� ;;.
Garege �5� '.� ,i7-,�z »� ..
`2i" ` �.t
� 4
Z�
O�Jqer improvements (6)
Tctal improveman4s (line 4 through lirre 6) (7�
Tdal value (line 3 pl'a line � (g)
1 hereby certify the above is W e, correct and � Signawre ot Pssessor Da�e signed
complete.
Verifying ecUOn - Signature oflwditor Data si8ned
-.v�".�.�`�`$,�.5`'e:.'�d5,+;�^...4i3'.�"-��.3'}-.'�'?fS�-F�s�`t3��"�.�€.?uvSTANDARD�DEDUCTION'ALIOWANCE .;��� • . �
20 _ Pay 20 _
Lesser of 12 Homestead
Valuatlon a $35,000 g
Sipnature ofNiditw Data signed
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