Mobile Home_Beal T c YEAR
i;��',� CLAIM FOR HOMESTEAD PROPERTY TAX Jr f FORM
'-_ �A CREDIT/STANDARD DEDUCTION (,// HC10
‘r, Jo, State Form 5473(R6/4-03)
Presoibed by the Department of Local Government Finance
INSTRUCT1QNS:See reverse side for filing instructions. I I
ms's,, , =:;x . .:.=,""'r rL-�_'.c `*.r " ,..r rCERTIFICATION STATEMENT.;:` ,:-c'b_ tt. °'�.4:r R :7— . .
h art_.-s —c: ��. k.<srv,.-e,#-. -- -- r�.��n y6 9ff�1ff�1
I(We) 4aY� , , Mr/ • :1�,/ / certify(yrleYon�d'14iHd of March,20
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑
alI(We)owned ❑ Are buying under contract 7Z'6,,, ���J�`/(�a(-//�
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns thBe_OOr�,,�rr �1-auyjgtlff fife a contract.
41):4a2:4: aNSA a e'gs'T'a�"3 ',* -*M CONTRAC-rRECORDED,«°'=' X-,'`a �t r .ps-:.+ yi r:=Foe aw-g���T -y
If buying on contract,Fee Simple owner's name '
Recorder's office where contract is recorded Record number Page
- '.' . �''S zu.:.r_..: tli, -.<,'.. gaAwaa �'..r-r P,ROP,ERTY:DESCRIPTION.#:'3 s3.a.'re!-h4 -tc&-tay.'a'J ixa?s ,i_:
County Township Taxing district(city,town,township)
Parce n Ai•-t L Agri• la the Property in question:
/ ICI'00dx72/--w //`/7J •—OD ill-LP oReal property L�/ A/o pile Homo(LC.6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produ income,describe the use and portion
of the property utilized to produce income.
`` '11-- ' .- ;lit, .-1 Virt';; alfiROP.ERTY,OWNED BY CLAIMANT;IN,OTHER'COUNTIESI; -te 'y nZ
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of i .nt
--X i /
idress(number and street,city,state,ZIP code)
111— 5v S . 5 W. (O',r,QT.t.ct,; e ,„ U 16‘fl`
; �ASSESSDR�U E�ONLY j`3 ,.744:_TRUE.TX ASSESSED VALUE r HOMESTEAD2 s.�'N N RESIDENTIAL -_ .
�-,._. 44.sz ..• f rte cf'z. _ _ie li e ALUE..C.e^^,ti,....ATx100%OFT7V 3>.z2 VALUE,',y�., e'.. a iu:S . V/LLUE'a3. ` *,
Land not exceeding 1 (one)acre immediately ? r ` 'r e 4`~,surrounding residential improvements. (1) I- fi °
t 4:33az_s��:
Other land ur' ;-r<:r1
(2) �'^r4 $ ._
Tctal land(line I plus line 2) (3)
Dwelling (4) '<�x��.d. y�
Residential improvements or Annually • '�
Assessed Mobile/Manufactured Home Garage (5) am: , `r 's''` is 5
' .,- z,-.
Other improvements (6) :-.fir a s
Ida!improvements(line 4 through line 6) (7)
Tctal value (line 3 pits line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
•r a -, _-: r', . -IITA-atW.g z.r, STANDARD DEDUCTIONAL'L'OWANCE tt-.>fs�. • 7.`; :a 5 u$�" ywt vi ca�`r•e <+
` 20 Pay o0_ 1, nI
^f--�\. Lesser of n Homestead '-f\�,\ 8 l kgel
U-�./ vauauon a 835,000 r\
lik
Signature of Auditor Date signed
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