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d'�� CLAIM FOR HOMESTEAD PROPERTY TAX
`�"" � CREDIT/STANDARD DEDUCTION
� � J SGteFwm5473(RS/1D-01)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side /or /iling insWCtions.
�.:i'#''`t.:��`"�a"-:: ; .:�>?� .,i''.. ".'_.. .:'CERTIFICATIONSTAlEMENT'':
�n YEAR �
FORM �• � — �
H�,o pa- 03 �
I(VJe) � certify that on the 1st day of March, 20_
I(We) occupied as our pnncip pl of residence the following descnbed real pmperty for which a Homestead Property T�c Credit is hereby daimed:
�I (VJe) owned ❑ Are buying under contract
�lave a benefidal interesl in the entlty ihal is liable for the pmperty taxes on Ihe property and that owns the pmperty or is buying under a contract.
If buy"u�g am m�Uaa, Fee Simple owners name
where
Couniy
Tavnship
- _ �:e'> - -_.,.frr,:7_._�; __ _ �",�s.,; • . _
Rewrd number Page
=,.+. �..+:'! ia�L`t : i _�u�.F>i `>.:" . `
;�t¢tvq rownship)
Parcel number Legal description Is the property in question:
���.. Q�'�$�p � a� ❑ Real pmperty ❑ Alobde Homo p.Q b f.l-7)
If any poAion o( the resWential sWUure w the Wnd not exceeding one p) acre that immediately sunounds that swUUre is used to produce inmme, describe Ne use antl potlion
ot the property utilized m produce inwme.
1:
I hereby certify Ihe above statements are W e, correcl and complete.
(number and 5heet, ciry, stafa, ZIP code)
7avnship
r.,y
�-~ ����"�ASSESSOR US O Y�tzxr?` Y:��'-�t� '>'TRUE TAX yF h ASSESSED VALUE >HOMESTEAD ��;NON RESIDENTIAL�{� ���
a-.ws�s, � �.ir<2. "._�"_ `c �_�.F 'n..e.,;�: � . VALUE�.: � :AT-100%OF-TN �;VALUE�* � ��.s_ ew ,.VALUE:�.C.:��azl+! �
Land not exceeding 1 (one) acre immediatety (�� 'w�ri �,�-L�� �"�4� - �A�� _!,.,:
surrounding residential improvemenls. ��-� ,_.,�r.�y;.��;.�;� �,,.�._..t , � �.
r x R� �{ 6
t t�a G
Oiherland (2) � .�,�+ .�,-?�
Total land (line 7 plus line 2) (g�
Dwellin �u�` � = t'� yz �� ��q�f- 3:
9 i4) 'i-t� �'h�'''.1#a� i`TF''^�`.v"'�`u.�ti
Residenlial impmvements " - .� ,
er
��'Ft'8"��ay�+}4"' . ".� F�..s/�'.
Garage (5� ��{�i;t �� �y E.. �'r=^'.:i : l �..
aV y, �
Other improvements (6) ` � �- � r -
t �5,1��'.�
Total improvements (line 4 fhrough line 6) (7�
Tctai vatue (line 3 phs line n (g)
I hereby certi(y ihe above is We, wnect, and Signawre o(wssessor oate signed
comptete.
Vailying aclion - Signalure oflwditar Date signed
20 _ Pay 20 _
Lesser o( tY2 Homestead
Valuation or 56,000
S
Sgnaturo of Auditor �� _ � � � �ale signed