Mobile Home_Baumgart OA CLAIM FOR HOMESTEAD PROPERTY TAX /�I�// FORM YEAR
• CREDIT/STANDARD DEDUCTION I ` / HC10 State Form 5473(R614-03) Y
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
e "v.-.-'-id'v'2x-'r��- -' t s,33"-=".--a,,.:: v`cA�•'t - CERTIF.ICATION,STATEMENT f "?*-r 'it.t: : 3s,,, s;�. ' ta:18. -Vas-. -.
I(We) A// // `1 I,J/I eA i A certify that on the 1st day of March,20
I(We)occupied as our principal place of residence the followin-3.escribed real property for which a Homestead Property Tax Credit is hereby claimed:
111 I(We)owned CI Are buying under contract
� —I 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.
y`5,07 ; 4$y? 1,1.41,•larnC8 n,fart-4,11fi'ax.:. "`'eictn-3_CONTRACT;RECORDED_}_,1- h.74:ay'g).:9-..-7.Q.:?-*.-d `'s tis2se agar;-:
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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'- L'' .fy._",alx4 "`�+`,�' s ;��'.',iPROP,ERT.Y.DESCRIP.TIONar`,`' ", '.:i.'r- t _;d: •r 'x 'v'�r- ' f '�-a _ro•
Gaunt , Tolvnship Toxin istrict( ry,town,towns )hip) (\
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Parc��m /5 / ) Legal description is the propertyji4 question:
v Real property ❑ Mobile Homo(LC.6-t1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
'2 - 03e.o o2-OU
le- - 'a..����`13- Jn .�t>` PROP.ERTY,OWNED)BYCLAIMANT;INOTHER'COUNTIESpanLmys �r�..i.4.'t'�w°`�r'„'�^,oilta
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and street,city,state,ZIP code)
�`T'i` ^ � '`'" " ' i ifftg "' e 1 litti TAX 1- ASSESSED VALUE OMESTEAD ' NON ESIDENTIALtt
AB {ritLISE ON'Yx f�thVAtUE ,,, SAT 100"h O TTV;s ,SVALUE ��w�'.- z, VALUE : ,.�{
Land not exceeding 1 (one)acre immediately ^I ?"CT t1PA13
surrounding residential improvements. (1) ,x I '
Other land (2) ;'` ¢ 5
Total land(line 1 plus line 2) (3)
�r w e x
Dwelling (4) .t' {3r.,,; '•• -r""-ta
Residential improvements or Annually
'Spitc.t.thM C- 4.: a.
Assessed Mollie/Manufactured Home Garage (5) lir"n _5 - ' 'Si
Other improvements "'' '-lS
(6) a .- .
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (S)
I hereby certify the above is true,correct,and Signature of Assessor • Date signed
complete.
Verifying action-Signature of Auditor Date signed
..�a� 4�.-_�".�'-` tm .#� .�%„�;i��;.�,�`��^'.?STANDARD;DEDUCTION'ALLOWANCE�-.9 u. rLk,r<a$e>.sai:�"a���k�s-e> '�3at��r
®
lt\ 20 Pay 20 y� 1
Lesser of 1/2 Homestead \1?? \� i _ ( \i\1)
vauanon or 535.000 \) \S
Signature of Auditor \ Date signed
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