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CLAIM FOR HOMESTEAD PROPERTY TAX PoRM �� YEAR
CREDIT/STANDARD DEDUCTION Hcto
State Fomt 5473 (R6I4.03)
Prescribed by the Department of Loral Government Finance
INSTRUCTIONS: See reverse side for filing'
-INM e ,;,r3 ; x rw, <q¢e:t� -`ate 'u "C .I TION TATEMENTic .y
°cam: ca _ _..._ x cam- Q:
certify I (We) certify that on thta..1U d& CU 20_
I (We upied as our principal place of reside ce the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I (We) owned ❑ Are buying under contract >a
�. Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr44r ig,gtr�pg unde a contract.
!r F l t' ` °- �a' 'o-,Ft' ."`s tets 'r•,c CONTRACT'.RECORDED y'a�- ,a^'zr�' c;, is-.a„ .- '°yT3�air -•` b'-xi tri- $z.�;. �..T.i -.ir ..:T'''ts`i
If buying on contract, Fee Supple owners name
Recorders office where contract is recorded Rexxtrd number Page
_2 .a:al` W E P, ROP,ERTY.DESCRIP jaf ..
County
7aanship
Taring tlistrict ry, n, wns " )
hereby certify the above statements are true, correct and complete. igna re of C12 ant
r- O
Address (number and street, city, state, ZIP code)
al description
Is the prope in question:
Y,p�'.yrASSES50RUSE ONLY -
_- _,;.sr
TR UE AX i
VALUE 1
ASSESSED VALUE
,AT3100 %'OFTTVa
HOMESTEAD '
VALl1E2N3_�+'dr'"'
�neai prope ❑ Mobile Homo ( /.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.
o� o S11,�a -6c .
?'- .- '..'�_xe. fr4.'""PROP,ERTYOWNED`BY CLAIMANT ;IN'OTHER`COUIJTIES,+La" _"v`a`f'r?p
County
Tmnship
County Twvnship
hereby certify the above statements are true, correct and complete. igna re of C12 ant
�M
\� t•
Address (number and street, city, state, ZIP code)
�2R ► � d�G -t ' l L � ��5
Y,p�'.yrASSES50RUSE ONLY -
_- _,;.sr
TR UE AX i
VALUE 1
ASSESSED VALUE
,AT3100 %'OFTTVa
HOMESTEAD '
VALl1E2N3_�+'dr'"'
i•" �' NONE- RESIDENTIAL
i,�`VALUE
A .'u
Land not exceeding 1 (one) acre immediately
(1)
E }; �`
surrounding residential improvements.
,ice
Other land
(2)
Total land (line I plus fine 2)
(3)
Ct' Y ^r...�i
(Residential improvements or Annually
Dwelling
(4)j?".)?q
s " �- ..
MEAN
w �' 'a
Assessed Mobile I Manufactured Hama
Garage
(5)-
, ` I' T t ,'•• r
,.3,"'rt- .w'�r,i+
Other improvements
6
()
IPM3�
Total improvements (line 4 through line 6)
(7)
Total value (line 3 plus line 7)
(S)
1 hereby certify the above is true, correct, and
Signature of Assessor
Date signed
complete.
Verifying action - Signature of Auditor
Data signed
of Auditor
20_Pay 20_
Lesser of 112 Homestead
valuation or 535.000
S