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CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION NAY 1 J 2003 HICto -Ukv
Slate Forth 5473 (R6I4-03) .� t ,
Prescribed by the Department of Local Government Finance
lbINSTRUCTIONS: See reverse side for filing instructions. 71 //
I (We) k�I certify that on the -list day of March 207
/- �- �^�-✓INI�L t —
I (We) occupied as o dncipal place of residence the following described real property for which a Ho estead Property Taz�Credit is here(iy,daimed
I 1 (We) owned ❑ Are buying under contract
SHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
�-.�.- -� <r;.= s..RS+F•. -�r: "sus • hz.- }h�3:iCONTRACT ?.RECORDED 'tsu 33 r -� - s: .•
s.,s -6 .x., _�}�- a_esrs3r�. r�c�..'"��'lt�''r•
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
'tea wASSE OR U E ON Y V
ssVALUEyr�
TRUE TAX ,K
�ASSES$ED VALUE
County
'"NON�tESO]ENTIAL�`n`
�,-
Tomship
Taxing district (pry, town, township)
Parcel number
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to -
Legal description
Is the property in question:
1 property ❑ Mobile Home (I.C. E1.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immediately surrounds that stru ure is used to produce income, describe the use and portion
of the property utilized to produce income.
t�' ry `��--��x
{P,ROP.ERT.Y;OWIJEDTBY CL'AIMANTiH; OTHER "COUNTIES L�'`.u`sik;'�- ;,,d5� -�' z' t^�'
County
Township
C0ly Toomship
hereby certify the above statements are We, correct and complete.
Signature of claimant
�ress (nu ben aM street,
" ,slate, ZIP code)
'tea wASSE OR U E ON Y V
ssVALUEyr�
TRUE TAX ,K
�ASSES$ED VALUE
HOIAESTEAD
'"NON�tESO]ENTIAL�`n`
�,-
,rx
. AT�00 /. OF�Tf V=
VALUEy$
frv`xyALUE --
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
7r• 7x ,`y-
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
B
Residential improvements or Annually
Assessed Mobile i Manufactured Home
Garage
(5)
•- - ; ` '
Other improvements
(6)',
a i =• ; sv�T
Total improvements (line 4 through line 6)
(T)
Sal value (line 3 plus line 7)
(6)
certify the above is We, correct, and
Signature of Assessor
Date signed
te.
EVy
action - Signature of Auditor
Data signed
20 _ Pay 20 _
Lesser of 112 Homestead
veluanon or E36.000
of ywdilw r k ,, p 0 e Q O ^ IDat9—U4—Oz I/