Homestead_BensonCLAIM FOR HOMESTEAD PROPERTY --T T' '� FoRM YEAR
} CREDIT /STANDARD DEDUCTION 'may Hc10
State Forth 5473 (R614-03)
Prescribed by the Department of Local Government Finance [[ p
INSTRUCTIONS: See reverse side for filing inslrucfions. DEC 12 2003 �, �'r �( _.w•� ,�\
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I (We) J ' GIBSOF: C: C' ' ' certify thabr�t�he�l Ordi�farch, 20_
I (We) occ pled as our principal place of residence the following described real property for which a Homestead Prope Tate edit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract V
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propert;�dbuyi 1- undue er contract.
NTRAC_ TRECORDEO�``' �s�z��' �•. s�E��. �ix�' t' �"` 3 ='�'��';�i'.;S., ;z."�;�°.'.�*�
If buying on contract, Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
.''- _'YT'.m�._'i=F.��� wsw3A€ r�S- �'• ':x�i`''�j���'Tair'.•`°„�;�;�3,; P, ROP, ERTYDESCRIPTION�iww ..'�.t'!??"�`*;3st ift' �, r�". 7- RS'-- ��sujh� ,>.�,"'4�.+- �,`_`.r',riao-�`_ --
County Township Taring district (dry, town, township)
P� .,.,....._. -- Li \ ?.�_�� p�•0 ' property in question:
�O S' D TJ liJ J r] Real property ❑ Mobile Home I.C. 61.1 -7)
If any portion of the residential structure or the land not exceeding one (1) acre that immeenatery snnounun u-, ..,.ctLire Is used to produce income, describe the use and portion
of the property utilized to produce income.
-/f 6 o3- do- 640, V6 -e /
Axs zY`.f�+�.' .'a -- ev�PROP,ERTYOWNEDBY CL'AIM,4NT:IN'OTHER'000NTIES �iT� '$:'p±.t��.`ire°>r,i'•ss�'f!""
County
Township
HOMESTEAD�'�
County Township
hereby certify the above statements are true, correct and complete.
VAI:UEF
Signature of claimant
®
numbe street, city, Mate, ZIP code)
Land not exceeding 1 (one) acre immediately
/G (�
's ��£' -wj x x
= +xASSESSDR O LY
�TRUETAXX>� —MV
f
ASSESSEDVALUE
"'AT,100WOEM
HOMESTEAD�'�
tNON E-R SIDENTIAL i t+
''
£ i r x
USE
VAI:UEF
-W
VALUEr`
"'" VALUE' ms's'
Land not exceeding 1 (one) acre immediately
7 "'g`gu.;>~",'Y- '.%''yvx" .
surrounding residential Improvements.
:. a.lw Tit.
Other land
2
yy
^V
Total land (line 1 plus line 2)
(3)
Dwelling
(4)4+s,T.',I"�•-
`e'%
i,
Residential Improvements or Annually
Assessed Mobile I ManufacLaed Home
Garage
—,
�•
(5)
Other improvements
(6)4`s"
''ts
Total improvements (line 4 through line 6)
(T)
Total value (line 3 plus line n
(6)
I 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 1P2 Homestead
valuation or 535.000
Auditor ' z-" Lj
5