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CLAIM FOR HOMESTEAD PROPERTY TAX FORM �'` YEAR
CREDIT /STANDARD DEDUCTION 7C7o Ij
State Form 5473 (R614 -03) JJ_-�J
Prescribed by the Department of Local Go,temment Finance
INSTRUCTIONS: See reverse side for filing instructions.
NOV 06 2003
as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ Are buying under contract
Have 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.
:.cumit`€ ski,' r�` a''''.; a' j✓' CONTRACTRECORDEDK-` '`'�`-sr'",.,,r°zA".f"''_'.'''� 3i'rs. iY •ra'.', -*'
If buying on contract, Fee Simple owners name
Recorders ofim where contract is recorded Record number Page
- "'tc;s'e:�... �..�?.iis- t"i- Y�rsr•
�'_•,,,.faPROPERTYOESCRIPTI Nis') <'.zF- tlz�.`'.?+'fa
County
Township
Taring d' (city, own ownship) i
S' natur of claimant ,
A4dress (number and street, city, state. ZIP code) ,
a lei Vim.
S"AT 100 °A'OFTTV
x -,.�i�
Prmlryber
/O-
description
Land not exceeding 1 (one) acre immediately
Is the PmpeM in u" On
/C
�al
/O
Real property Mobile Home (W. 6 -f.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that imm
iatety surrounds that sU6cture is used to produce income, describe the use and portion
N the property, utilized to produce income.
`" �.= � '= -i�.��"3"'��'= ,r���R3'i,:�z =� �PROP.ERTYOWNED:BY CLAIMANT:IN OTHER' COUNTIES.. ACS• f; ��" ��' ",�`c�'�`v_- °£`�C'";!'Y�'ls.�`_
County
Township
County nship
I hereby certify the above statements are true, correct and complete.
S' natur of claimant ,
A4dress (number and street, city, state. ZIP code) ,
a lei Vim.
dr
x 1ASSESSOR�USE
TRUE TAX-
ASSESSED VALUE
S� OMESTEA
''ay
N3tESIDENT
�'.., Ta�S' N$Y- '#n.k4w.'e•. :'eu!w.
•YVALUE
-.,-. . Sri'`..
S"AT 100 °A'OFTTV
x -,.�i�
VALUEr'3"°^TVALUEn4`
c�R4t,._ _.tp
s� .+. a
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
Other land
(2)
�'`•""�Y�"'
TUe1 land (line 1 plus line 2)
(3)
Dwelling
4
c'-
ResidentiellmprovementsorAnnually
Assessed Mobile if Manufactured Harre
Garage
(5)
.z
Other improvements
(6)
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Vaifyirg action - Signature of Auditor
Date signed
11 iSTAN6ARU '.DEDUCTIONALLOWANCE"`"'''�
20 _ Pay 20
Lesser of 112 Homestead
$
valuation or 535.000
Signature of Auditor
Date signed