Homestead_CordrayCLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
State Form 5473 (R614-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS See reverse side for filing instructions. tl
-"CERTIFICATION STATEMENUO -4
— - `- Off6F�'
I(We) D6V l d C' 4 V(rnbcy(i, 4 certify th MAY
I (We) occupied as our principal place of residence thg following described real prop Arty for which a Home?�e — d P at on the fs't d4� March, 20PA
a Property Tax Credit is hereby claimed:
❑ I (We) owned ❑ Are buying under contract
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the P`to-06 -"-o-i�vis7Lyina--uinide�f-a-gntract.
Got r, -
NTRACTzRECORDED
If buying on contract. Fee Simple owners name
Recorders office where contract is recorded Record number Page
s Iii-k6PE IRTY.--DESC RURT16N
County
County --17—nship
Township
Sig 7oloraimant
RIM
Taxing district (city, to", township)
Soo
.M
Land not exceeding I (one) acre immediately
Parcel-number
O4,S01
Is the property'
question:
Real property ❑ Mobite Home (W. 61.1 -7) .
any portion of the residential structure or the land not exceeding one (i) acire that immediately surrounds that structure is used to produce income, describe the use and portion
of the property utilized to produce Income.
Nlfi - 36 -
e5I6
---X
IA ME W, C '
I USE 4
County Township
County --17—nship
I hereby certify the above statements are true, correct and complete.
Sig 7oloraimant
RIM
L and stme ate, 71P code)
I Z s V1 I 4y� Q 1 (0 (11
---X
IA ME W, C '
I USE 4
E TAXZ
5`—i
,NON- RESIDE NTIAL N A
L W &
X -
.M
Land not exceeding I (one) acre immediately
surrounding residential improvements.
Other land
(2)
Total land (line I plus line 2)
(3)
Dwelling
(4)
70511 EMU"
, iW7
MEN
Residential Improvements or Annually
Assessed Mobile Manufactured Home
Garage
(5)
01'5112",
'; 01,15-
A!
Other improvements
(6)
MINE 11 W,
Trial improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
1(8)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
I
Verifying action - Signature of Auditor
Date signed