Homestead_WhiteCLAIM FOR HOMESTEAD PROPERTY TAX
CREOIT/STANDARD DEDUCTION
State Form 5473 (R6 / 4-03)
Prescribed by the Department of Local Govemment Finance
INSTRUCTIONS: See ieverse side /or filing instn�ctions.
�
FORM �� YEAR _
HC10
:T �
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I(We) ���j`� �'°�. LLI�� �pC � t.wK/-r.c.e� certify that on�the 15t day�ofMarch, 20
c.ia<., r i:�
I(We) occupied as our principal place of residence Ihef/ybOCyri ,d escribed real property (or which a Homestead Property 7�c�Credit is hereby daimed:
❑ I(We) owned ❑ Are buying undercontracC GI850N COU�TY AUDITOR
, Have a beneficial interest in Ihe entlty that is liable for the property taxes on the property and Ihat owns the property or is buying under a wnVact.
I( buying om m�traa, Fee Simp�e owners name
ofice where conVacl is recorded
County
Tpvnship
district (ciry, rown, fownship)
Record number � Page
Parcei number """"O"'�` j`�Legal descr�ption�. .$F SF
�6-�o�3a-Yov-oo�{ �'�4 /� C Isihepr rtyinQUestion:
.7.qa -oa� I 3a -,� - i,�. ❑ Real pro0 ❑ MoD'le Ho o(1 C 67 7-7)
If any poAion ot Ihe resiAential sW cture w the land not ex ing me (1) aae that immediatey wrtounds that struCUre is used to produce income, tlesaibe the use antl portlon
or iha propetly uGlizeO b produce irrcome.
� �, �.o- I D' � �-1 � - Cx�
�I. 3ay -oa �
Counly
Tavnship
I hereby certify the above statements are We, wrtect and complete.
(numbe� eM streel, ciry, sfate, ZIP code)
County
Tavnship
��� 1SqqiTX'Y � �YfS�Js �e{.'�.TIS"� iS'9r s `tw '� `i- � ° - � -�x'�'=" "° . . ,� .
� �.r TRUETAX�z�y� ASSESSEDVALUE �HOMESTEAD,m.�- NON-RESIOENTIAL'���='
�� ASSESSOR USE ONLY �, �,.,'�.�,2�-g zy � r e� o f y �
s:`���.s,��.�+Y .P�-,.-�5�','_��`._.,�v_��'t��:.�:x�-•�VALUE..'`�+.rr.,....�.AT�100/aOFTTV��;;n..VALUE�..� Q y-%L�VALUE...�?���y�-�j
Land not exceeding 7(one) acre immediately "a',-�'s-ss.'�+,'��'+�.��'S.�.�a.-�5���+��1 -¢
sunounding residenlial improvements. (�) ���'����.a+'$�`-...,r���5;
Other land (Z) ��"���v� .
th �
� N�� �
Tdal land (line 1 plus line 2) (3�
' ra .�.�-�+`.'-
r `�Sya. �r��7,
Dwellin9 (4) ���t!.d.�l~ �U �s''��f�
�Residential fmprovemenfs orMnualty �'�--"�
�'�fh{" �,� Ciy?�'.
Assessed Mobile I ManuFactured Home Garage (5) ����c����� . °Y�'�`R��
'.S.i..��Y'x' r.e�`+�i-K�']5,'
Other impravements (5) �i������'��
a
Tdal improvements (line 4 fhrough line 6) (��
Tctal value (line 3 plis line n (g)
I hereby certi(y ihe above is We, cortecl, and Signamre ofAsseswr Date sgnetl
complete.
Verifyim� action - Sig�ture oflwdiWr Date signed
�.''�i,'�`tc'�''� �Y�*',.,`x-z�ir�i���r'����JiSTANDARD:OEDUCTIONALCOWAlICE? yfy-��y�,'"�y�;���?`;£fi"r�i"" ""`"
'�' . �.�f'��`��a:z�
20 _ Pay 20 _
Lesserof 1/2 Homestead
valuaUOn or E35.000 5
Sgnature olAUddw � Date signed