Homestead_CampisiCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT /STANDARD DEDUCTION 10
Slate Fonri 5473 (W I 54M
Prescribed by the Departinent ef Local Gum"irrent Franco
INSTRUCTIONS., See reverse side for Ming instructions.
' QATMIffATEWWT '4 `- A-"
II (We) certify that 00P 1st da of March. 20
0
I (We) occupied as our princi
10 pfpleo�rer ence the following described real property for which a Hornestaa�o claimed:
I (V*) owned ❑ Am buying under contract COUNTY AUOITOR
Have a beneficial interest in the entity Mat is liable for the property taxes on the property and that owns the property or is buying under a contract
CONTRACTRECORDIM(r,�.'
If buying m mrttract, Fee Simple owner's riarne
RKorda's ds® where cmftd is receded Record number Page
PROPERTYDESCIMPTION)e-�-,` k"
OWNED BY. CLAAdMT IN ER COUWhES 'R
County
Tomnstmp
Time disbi 9,11y.
from. fqFfi1Q%*)
Parcel nurriber
' AT,100%'CW
L-0 descii
V
VALUE,:
rm"'m' W
W7=
ifiallilikess (mrnbar and sheet ch),. slab, ZZP
A
6& �
r
Ey Mobile Home (LC. 61.1 -n
if any
the nesKlerftal structure or the land nol exceeding one (1) mixe dot enrimmlataly anroundis
strudva is used 6D prod" i m. . descrbe the use and Portion
at the
utilized to prodime
(2)
A:s USE ONLY �0,
OWNED BY. CLAAdMT IN ER COUWhES 'R
County
Township
County
Township
I hereby certify the above stalminents are true, correct and complete.
' AT,100%'CW
V
VALUE,:
rm"'m' W
Land not exceeding I (one) ac:re iffmadiately
ifiallilikess (mrnbar and sheet ch),. slab, ZZP
)
r
0310 Co.
A:s USE ONLY �0,
TWE TAX .'
'�HOIIIESTF"
--
VALUE
' AT,100%'CW
V
VALUE,:
rm"'m' W
Land not exceeding I (one) ac:re iffmadiately
'� %"
surrounding residential improvements.
Otherland
(2)
Trial Land (line 1 plus firre 2)
(3)
Dwelling
(4)
Residential unproverrients or Annually
Garage
Assessed Mobile I Manarlactured HOFT10
(5)
Other improvements
(6)
Tdal inpovernents (fine 4 through Ine 6)
(7)
Tdal value (line 3 plus firm, 7)
(8)
I hereby car* the above is true. correct, and
conviele.
signature of Assessor
Date seed
%%ntying action - Signaftm of Xxitiv
Deft signed
STANDARD 1XWUCMMALL0WMCE-*
20_Pay2O_
Lesser of 112 Hornestead
$
Valuation or $35,000
Signature of Amclibir
Dais signed