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CLAIM FOR HOMESTEAD PROPERTY TAX FoRra
TEAR
CREDITISTANDARD DEDUCTION
State Form 5473 (R7 I 5-M
Pmaoribed by the Departnieni of Local Govenvnert Finance
INSTRUCTIONS: ONS., S as reverse side for Ring instructions.
CERTIRCATWN STATEMENT
I(We) 1��VWJ.WAAVAMLA. certify that on ot marchz;;;;�
ffescritled which I Homestead Property a be"
I (We) occupied as our princi pa� w —[�� the &VwingrmSft! -rUea==fm IT
I (We) owned ❑ Are buyng under coritrect
Have a beneficial interest in the entity thad is liable for the property taxes on the property and dot owns the property or is t ender qAntract.
:.":''"�-��-CONTRACT�RECORDED,;�i` ."i',
If buying an cordraM Fee SmVle owners mere
Recorders office Vrhere contract is Iemdad Record number Page
;,,,; ASSESSOR USE
4 PRO PERT*.bEscmpnoNk,:-
Tomnship
County
Township
Tacing district (cilK town, lownshV)
Parod nwrbw
Legal description
Is the properly in question:
21n-jq-jRjD3-=
00 -Do
I [I Real pop"
❑ M.Wl. Fl.. (CC. 6- 1.f -7)
a
If any portion of the rewderdial struchAm or the land net ameacling one (1) acre bud mrneckatety, suffourwds that StrucIum M used to produce income, descrbe the use and portion
of the property utilized lo prod" incoine.
14 Ld
;,,,; ASSESSOR USE
County
Tomnship
County
Township
I hereby certify the above statmmts are true, correct and complete.
'*-%(n-6- and street ol): state. ZIP code)
I /Sl q Lj . (- err 6+, OL Una
I t4 LA 6
;,,,; ASSESSOR USE
TFtm fAic
ASSESSED VALUE
Lesser of 12 Homestead
Valuation or $35,000
Signah" Of Auditor
Dele sUned
Land not exceedng I (one) acre inwnedabsty
b j-
surrounding residential improvements-
Other land
(2)
Tdtal land (line 1 PW3 late 2)
(3)
Dwelling
Dweng
(4)
61I.N
Residential ffriprovernents or Annually
g
Garage
4
Assessed Mobile I Maradachiled Horne
(5)
Other mprovmnlents
(6)
Tcbd ffriptovernents (fire 4 ffyough fine 6)
(7)
TctEd value (Ii?e 3 plus fine 7)
(8)
I hereby ce" the above is bue, conrea and
cornplete.
Sgnature of Assessor
I
Date signed
%kff " action - Signature of Auditor
T�
al"ne"
STMDAM0EWCTMALL0WMCE',
20 Pay 20
Lesser of 12 Homestead
Valuation or $35,000
Signah" Of Auditor
Dele sUned