Homestead_HazelwoodCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (8614.03)
Prescribed by the Department of Loral Government Finance
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NTR/1C_T;RECORDEDias' dal•.:,-,/`.': �?�s '`,':«�'�'�i�ra.,�;�.::,�':*liF
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Re rd number Page
aav f` ayyl'.
w- - �`�- .- .:>= �`-..;'zrr�.� -�'7�i �?� P.ROP,ERT.Y.DESCRIP.TION�r ``�`,'�'"r• {,+"'� -� _ -
n
Township
HOMES
Taxing district (city, town, towns
Par, nu r
Leg al�d`��crt ion
\�/
TA;ASTSxE1SSED.VALU�
OF00 T
I e party in question:
eat property ❑ Mobile Homo (I.C. 61.1 -7)
if any portion of the residential structure or the land not exceeding
of the property utilized to produce income.
) a that i iatety wnounds that stnFle is used to produce income, describe the use and portion
'5 "W''�+W._. f 'rn - °° `"PROP.ERTY.OWNED'BY CIAIMANT;IN',OTHER`COUIJTIES °.,.s n . ' ;,' ,,,. °a d" "#1 ^g^' {
County
Township
HOMES
County
Township
hereby certify the above statements are We, correct and complete.
TA;ASTSxE1SSED.VALU�
OF00 T
Si nature of claimant
oVALUE =1:uI,
^ddress (number and street, c state, ZIP code)
y S Oa/� 1 C���
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4�7� 6 0
M
R US Y
RUEUE
E'
HOMES
N L�
TA;ASTSxE1SSED.VALU�
OF00 T
VAL
oVALUE =1:uI,
Land not exceeding 1 (one) acre immediatelyt°kTl'�w�
sh;irrt" -t:.ir
surrounding residential improvements.
Other land
()
4$4�
Total land (fine 1 plus line 2)
(3)
Dwelling
Residential Improvements or Annually
Assessed Mobil / Manufactured Hama
Garage
5
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 true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 1i'2 Homestead
valuation or 535.000