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� CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
-- � Slate Fwm 5473 (R6 / 4-03)
Prescribed hy the Oepartment W Local Govemment Finano=
INSTRUCTIONS: See revcrse side lor liling inslmctions.
t,.� � -a '�-1 T�
FO�M� , AR
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I(We) � 1 "1 � ertify ihat on the 1st day ot March, 20_
���I({{yW,,,��^e) occupied as our princip I of residence lhe following des " ed real prope for which a mestead Property Tac Credit is hereby daimed:
�(We) owned ❑ Are buying under conlract
, Have a benefidal interest in the entiry ihat is liable for the property taxes on ihe property and that owns the property or is buying under a wntract.
I( byvg on conVaG. Fee Simpie owners name
Recorders ofiice where conLad is remrEed
County
Tomship
town, lownship)
Record number � Page
P/aQr�cel �n,-1 �(mber �' ► lX`/ Legal desc^rip1tion 1 .�r1 ({�p Is tl�e prope m question:
l� J� • � � / v ��Q'� i '^- I �°� DroPeM ❑ Mobile Homo P.C. 61J-7)
It any portion of Ue residenlial sWClure w Ne tantl not exceeding one (1) aae ttiat immetliatey surtounds that sW e is used W produce income, desuihe the use and portbn
of the property util¢ed tu produce income.
County
Twvnsnip
I hereby certify the above statements are W e, correct and complete.
(number and sVeef, city, sfate, ZIP code)
Tavnship
n���� �'`�`-'�+`���'�£'�� � �`�".���a� `�'TR EcT��h��e ASSESSED VALUE HOMESTEAD�` NON=RESIOENTIAL e�
��+�.. �'ASSESSORUSEONLY �� .Fyq[UEuT�3c'fAT�700°/'OFITV �'�VALUE����',���5"�VALUE�-^���'�
x-:£�.s.d+ .�w-u.� '�t.rt�'4Y�;.':�Fa>._..� `§+"s.�S:.,,d �w-_ .� . .a -»£ .�;��t•^ . ,�z,_ -iL_4=.- `2
Land nol exceeding 1(one) aue immediatey � t'�g�.r� �`=�"�" 1.{F�3� �.'�'�„� 4
surroundingresidentlalimprovemenis. ��) ���"'`s���a;=����
���rc ��`
Other land (p) t��,--.��.x`x-
,��.� -_
Tolalland (line 1 plus line 2) (g)
�"�r�t:'c�'. ' `,ty�s+ =3
Dwelling (4) d• ¢�^et f.n �' d �y
Residentiel improvements w MnuaOy '� F* t� �a�"��
0.ssessed Abdb I Manufadured Hrnrre .`��?�" �` n1.z,''�� '�"
Garage (5) ��`� =.�,+�"� F?��
.'�'�t� w'�i
Other improvements (6) �z'�`5��.�
Y 3. z l�+l
Tatal improvements (line 4 fhmugh line 6) (7�
T[fal value (line 3 phs line n (g�
I hefeby tefUfy the above is We, corred, and Signature ol Asseswr Date signetl
complete.
Veritying aclion - Signature otfu�Eitnr Date sgneA
�����'��-•.-�``t�i'J'�.��3!��a�"�v.�'�c'�STAN�ARDOEUUCTION'ALI:OWANCEtr'��'>�.�r.����`-�:'�� '���� �'
Y _ � ��.....5 ; �-G
.,. . ` 20 _ Pay 20 _ -
Lesser ot 1/2 Homestead
vauanon or 535.000
S
SignaNreofAuditw � Datesign
1 - D-