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Homestead_Dearing (4)CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR } CREDIT /STANDARD DEDUCTION HC10 State Form 5.473 (R614-03) Prescribed by the Department of Local Government Finance. INSTRUCTIONS: See reverse side for filing insfrucGons. .r"� a? ! CERTIFICATION STATEMENTirr�',! � n •- ?- `?s�•f•.jc* 'e'ay,.i.f3 .g - 1 (We) certify that on the 1st day of March, 20 I (W/ occupied as our principal place of re enco the following described property for which a Homestead Property Tax Credit is hereby claimed: I (We) owned ❑ Are buying under contract 0 Have 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. .F�. CONTRACT' RECORDED A h T ::.'e'& ".�Et�`Z`J•sRa +"3.�' >�r'�3 _-`#.,�r�:��'f :•q.� .I n`�. "'�Z'? rtzr•- w�F�.'�''V.Ta�'` *�+6'.�;�'" `n�..� If buying on contract, Fee Simplo owners name Recordees office where contract is recorded Record number Page 4+"'',ki ? 't Rs"`.5_?- ?-'.°Y:i '-'r r' a � `P,ROPERT.Y DESCRIPTION t �_ _ i F i-' t :? -'r -r"-• - . v^r_�•: .t. = `. o .�,Y.� County Township Taxing oistnt (city, town, township) Parcel number Le description I Is the property uestion : Zeal Date signed / property ❑ Mobile Homo (I. C. 6.1.1 -7) If any portion of the residential structure or the d 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. ' Yl 7oP A2.L (3) County hereby certify the above statements are We, correct and complete. Address (number and street, city, state, ZIP code) County Signature of claimant SSES OWUS � �= v ASSESSOR�USE ON'Y- ^ k -,• _- „�,K_.•;t:' ,F_- ht.,:. =" TRUETAX '',F,VALUE_n -y v: att_ ASSESSED VALUE z`' °_' AT100A HOMESTEAD'S w " ANON= RESIDENTU\L �'` ? +: s EM MA, �c -. M °t<G Lr�f`i,.a ...- ,.csks. Land not exceeding 1 (one) acre immediately surrounding residential improvements. (1) Signature Date signed x Other land 2 ' Total land (line 1 plus line 2) (3) Dwelling (4) Residential improvements or Annually Assessed Mobile I Manufactured Home Garage (5 ),Y�''�t° Other improvements (6)r's-,_, Trial improvements (line 4 through line 6) (7) Total value (line 3 plrs line 7) (6) 1 hereby certify the above is true, correct, and Signature of Assessor Date signed complete. Verifying action - Signature of Auditor Date signed - - .ceie... -_ ifs I L s;3 y =s. Z✓ , f¢ r'^ ""n ,�...rr3r*.s€3i` o�=`. :.STANDARD'DEDUCTION'ALLOWANCEa 20 _ Pay 20 Lesser of 112 Homestead Valuation or 535.000 $ Signature Date signed