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�. t CLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT/STANDARD DEDUCTION
� � Scate Form 5473 (RS I 10-01 J
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See reverse side for �ling insfructions.
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FORM M � — ,
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1(We) `� C/p%� �,(!/�}l' certify n t sl day f M � h. 20_
I(We) occupied as our principal place o( residence Ihe following described real property (or which a � , v i:U IT R eby daimed:
�e) owned ❑ Are buying under conlract
e a benefidal interest in the enlity that is liable for the property taxes on the property and that owns the property or is buying urder a contract.
'e"e{*_-"�'�..rY3�ts'-__.�kr'P3,i`.�lms`i,.�S%v^�s`�'iy`�rt�'.--�..;::�-`�•_,5=-:,CONTRACT'RECORDED-::<`t:. ca.'.'ti,. T.. _ ;3 . .
If buying om m�traa, Fee Simple owners name
Recordefs olfice where conVaq is recordeE Record number Page
Counry
Tamship
�!7• c.EJiau -v� I (lllC��(.U�1 L
If any ponian ol Ihe residential structura w the land not exceeding one
of Ihe properry utiized to produce income.
(�ry.
the pmperty in queslion:
�Real pmperty ❑ Mobile Hwno Q.C. SiJ4)
�ds Ihat aure is used b D��uce income. describe ihe use and poNOn
�z"'y'�x.}y.:�yi,�,��{-..,'� -.s:<n'PROP,ER7Y.OWNEUBYCL'AIMANTINOTHER'COUNTIES _, ���-"t`�.`r- �'<.�.. �-'r=:��� �`���
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County Tavns�ip County Tavnship
I hereby certify the above stalements are W e, corred and complete. Signacure 1 at ant
� �� (num6eianCo'tree(, oiry, state, ZlPcode) _
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�"'�.�t'"j�'�*'`�' "�"�� "�"`4� �' '''�'��` � ��' * ASSESSEDVALUE HOMESTEAD' s NON-RESIDENTIAL'� "' �
•`�??�„ ASSESSORUSEONLY . �� ` -�'� TRUE7AX ca.. �F # �� . . -'':?�:.
� r�� . � .'��,�:3� ...E���€'�:�-_ .?�_ i��� �zt"+.,.VALUE� � � . Ai 100/a OF.T!V . � , `VALUE�s.-o,... ty ,� s � ' VALUE ,���4 ,
Land not ezceeding 1(one) acre immediately �= t„�s fir "�, t1. .�"� �
Isurroundingresidentialimpmvemenis. (�� "� �'�r.+_��+;s_ -, ��.=
� :�,�r .s� •`
Other land (Z) �.`,'-S_,,,,� �3y
e..�.�.. .
.�..:.xr.: ...:ac.
Tdal land (line 7 plus line 2) (3�
Dwelling (4) �a. %,�.i ��, i�� �:'� �rh �
Residentialimprovemenis '" £ ''����'�"'r''� �' °'s��'
�.i,(�'n�t u '� .�'Y`sf.�t.-i .
Garage (5� ��.�� ������:-,5.r...'-_.
.i:s+s-. r= G�, ���:s:;..
..'a:,� a z,a:.-. �... _ _
Other improvemenis (6) � : �. � �3,�
�.,-s
Tcial improvements (line 4 fhiough line 6) (��
TUaI vatue (Gne 3 plus line � (g)
I hereby certify Ihe above is We, covect, and Sgnamre ol Assessor Date signea
complete.
Veri(ying aclion - SignaNre oflwditor Date signed
20 _ Pay 20 _
Lesser o( 1/2 Homestead
Valuafion or 56,000
SignaWre of Audaw
3
Date signed
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