Homestead_BuryCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION i�� r Hc,10.�
State Forth 5473 (11614 -03) Fly ,Y g ,
Prescribed by the Deparbnem of Loral Govemment Finance 1gL�
INSTRUCTIONS: See reverse side for filing instbuctions.
(We) certify�L•on the'XSl -day of March, 20
(We) occupied as our principal place of residence the follo escribed real property for which a Ho staeaa�� Pr���(y a it is hereby daimed:
&alttJU F,,.IJTY �UDI Is h
5QWe) owned ❑ Are buying under contract
KHave 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.
..`'a V: sCONTRACT ?RECORDED ss'ci s„''' ',•J"4`. q'.e' ' e" $'{>•�",s ^•yG` ;• t sc sir.
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
..`§>`�''i,.'S+c- -- s:.'�zY, rte- �-3��*v'ba`�.„�'x`' c �.i�.�5�.ra?:. P,ROPERT.Y,<DESCRIPTION.�w: Y��'ti�'r[�'a'�s•°'°��a'�- ��'��'1:�>':�r.
County
TavnShip
Taxing district (city, jywn, township
Parcel number
Legal description
Is the property in uestion:
541 property ❑ Mobile Homo (I.C. 61.1-7)
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 utilized to produce income.
t, _. -;sz-"aTr,,.:�.""'r3 zPROP,ERTY.OWNEDBY
County Township
County
Township
I hereby certify the above statements are true, correct and complete.
Sign ure of claimant
Address (number and street, city, stare, ZIP code) -
Alp- aTRUETAX
-r �i1 �., ASSESSOR USE'ONLY
2,r2 e. :,.<.: ttIl 's- Mti.T�•:, x.s '+
cs�` ..
.:VALl1E•» _
ASSESSED VALUE
e
AT•700 %OFTfV
r +HOMESTEAD�x
Ys VALUERS +
r "�
(N+RESIDENTVIL -:
�•�VALUE "`
...��e
Land not exceeding 1 (one) acre immediately
surrounding residential improvements.
O
- •����,� -��, r "-. `�s
1
Other land
(2)yv'
-t�`-
Total land (line 1 plus line 2)
(3)
'Residential improvements or Annually
Assessed Mobile I Manufactured Home
Dwelling
Garage
4
(5)
rF e
•iMOM-
Other improvements
6
Total improvements (line 4 through line 6)
(7)
Trial value (fine 3 plus line 7)
(6)
1 hereby certify the above is We, correct, and
complete.
Signature of Assessor
Date signed
Verifying action - Signature of Auditor
Date signed
20 _ Pay 20
Lesser of tr2 Homestead
Valuation or 535.000
Signature