Homestead_RauschCLAIM FOR HOMESTEAD PROPERTY TAX
CREDIT /STANDARD DEDUCTION
State Form 5473 (12614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS: See reverse side for filing instructions.
I (We) ��` -"—'� i �-'�""'�� — r fyNat•dn theist day of March', 20
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FORM YEAR
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ONTRAC_ TRECORDEDrL'=- "a'�,"zi= '`d.,;F"7°'47'oa-`ds2
If buying on contract, Fee Simple owners name
Recorders office where contract is recorded Record number Page
eta' OW -OT9 " M-- RQ�''' -
.3-.eE ',. ",,iP.ROPERTI�<OESCRIP.TION�..
County
Ta ship
Testing district (city, towp, township)
\/perry
Parcel number g // ��- �J1
'C/
L de ' n
Is the pm iq question:
Real property ❑ Mobile Home (1.C. 6-1.1 -7)
If any portion of the residential structure or the land not exceeding one (1 acre that immediately surrounds that structure is used to produce income. describe the use and portion
of the property uti1h, to produce income.
X ,�`^,t f .s � �PROP.ERTY;OWNEC RY6E kI IA- Nt IN OTHER 'COUNTIES°F`s,_A�'c'.kgbA—
County
To nship
County
Township
I hereby certify the above statements are We, correct and complete.
Sig at o laimant
A xE00 %'OF'TTVyHOVALUE�'w
9,FT: .,
Address (number and street, city, stale, ZIP code)
VALUENTIAI"'�
kcu"ri x.. ... a3. •a
`'%�',P #ASSESSOR�U E ONLYf zr'��"
.
<xALUE x���
A xE00 %'OF'TTVyHOVALUE�'w
9,FT: .,
<.,- ....,. •?
VALUENTIAI"'�
kcu"ri x.. ... a3. •a
Land not exceeding 1 (one) acre immediately
G r_
surrounding residential improvements.
as _y fli
Other land
(2)
-'?,.,
sE
Total land (line 1 plus line 2)
(3)
Dwelling
(4)
,
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,�' - -
Residential improvements or Annually
-
Assessed Mobile I Manufactured Home
Garage
(6)
_
s ;3 y
s_p
Other improvements
(6)
D _u i M.
Total improvements (line 4 through line 6)
(T)
Total value (line 3 pits line n
(6)
1 hereby certify the above is We, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20 _
Lesser of 112 Homestead
valuation or SM.000
Signature of Auditor
3
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