Mobile Home_Antey �\ CLAIM FOR HOMESTEAD PROPERTY TAX FORM n CREDIT/STANDARD DEDUCTION HCIO
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State Form 5473(R614-03) ,
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Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See
the entity that is liable for the property taxes on the properly and that owns the pro errty87r j,r sort g(gn C 1 I00fi act:
:atiiirt::�.W,:::: r' ;.. . . ,; ,a.:_-�:r s: . :=;;' . CONTRACTRECORDED ' _ .... SSUH 1,;t:;;'.-• •.
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded I Record number Page
=PROPERTY DESCRIPTION'' . ' '
County Township Taxing d ct(city,,,town,township
Ir
Parcel nnuun � Legal description Is the property in question:
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—CO 1 7R O-Ca 'q el LO (-O LA iffid-� ❑ Real property Mobile Home(LC.6-1.1-7)
If 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.
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``"�' "`z Y •�.;��' .PROPERTY OWNED BY CLAIMANT IN OTHER"COUNTIES � � t -•. r✓. - -
_.Win.. •s<:,,.v F _ : >- ::,..: . 7',t';±-"Cc:.:.
County Township County Township
I hereby certify the above statements are true,correct and complete. Si\gnyatu�re)ol laimant
Address(number and street.city, /v r �rn
( ry,state,ZIP code) / 11
•
4-zx k`s/t:1r'!ASSESSORUSE ONLY _ TRUE TAX ASSESSED VALUE : HOMESTEAD NON-RESIDENTIAL,,,
>.;.w'lti...L .<<.. - .„..a •. VALUE - AT 100%OF.TTV- : VALUE ''•..`.'.VALUES: L
Land not exceeding 1 (one)acre immediately I :+; ?�-=”` - .-.
surrounding residential improvements. (1) '
Other land (2)
Taal land(line 1 plus line 2) (3) I ^-
Dwelling (4) .°;:�x:3 'F ' .;.' :
Residential improvements or Annualty - _,r_y.Y__ . -
Assessed Mobile/Manufactured Home Garage (6) - ..
Other improvements (6)
Tctal improvements(line 4 through line 6) (7)
Taal value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
•I._•"':'' raYr1.1t ; ' 1- •STANDA D.DEDUCTION A4LOWANCE
�:. 26:5 Pay 20 05
$ r1
�`\ Lesser of 1/2 Homestead \ \\ \r 1
Valuation or 535.000 1
Signature of Ayp[tw//jj pp. (�' 1 / 'Date signed
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