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• ---;- -t CLAIM FOR HOMESTEAD PROPERTY TAX ifre......FORM YEAR
CREDIT/STANDARD DEDUCTION iz-Hc 1 o
•,,,,,:zsz_, State Form 5473(R5/10-01)
••••
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
5.E....• _
2
,(,,e) ociAtkiap oi....u..d.. certify that on op Eg d2/71 Ny2 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:
0 I(We)owned 0 Are buying under contract / i / /
save a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr.".- : /I.-c a er . a !
Opi
:SON 0' 1 1 ts131-).1k-n) 1
E,g4a74551Mtt-4.44,igt-1-grieWi:eatrertatil.cn[CONTFtACT.:RECORDEDZt-tteia-L5F.re..)4,4.%-.1dt.1/4-;914-"r.*-W..120,01U:71;.Vc:;)-*1-: ,-.
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
t1-1.4-iag.421,,V.6r,;.114&-Witigt ,t-ra;.-T-Ir14.11a.r.:-.(ERoptitti<litsdRIE-TioN:g1S714'64,a.!--ct:ItAM-P-4i'a'in-71.;-tcci tra::-.2417-..r?.;
County Township Taxing district(city town,township)
Par I n r LegaLdetrigition Is the property in question:
°.. 60193-CO 1 '9 Hp Ell Real property dbile 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 produce income,describe the use and portion
of thmrp‘utilized to produce income.
ari--1 tAb
a4twurta, ek.
i. .Kir.r..,.... __s.t,.,,-:r, .,i,:ktaL.-;:,F!ROPERTY:bWNEDBY CalMANT IN.0THER'COU NTIES'W,r4_:•W'ciltaft:ctiff-?i.c."4:Y1§3g;=-15-14:-WP:I'
County Township County Township
ignatu - of claimant
I hereby certify the above statements are true,correct and complete.
'It 7 6624.0Lat-laorifie
.,- ;I (number a Ad street, " ,state,ZIP code)
L';. 1 • Gs. . co .— il 4 7 (905-
1t
.g.ne. .,Al t-Wer ti ci en i PI a t i tir,a7im,41.r IV L:,,,I.f:Wirktlia111-tl-eri 'itiagiiipiirti*. ',...!2ii:Iliaiiiraii:::1 Ait4510:igiiirliglt?
0-itati"Wk4,15;r7fM1 -—3-tialSZ-NW:14W1 ZWVALI1EFS1=4"iii&i99%.Prawf..*AT-vA,m4g.1"---F,tr AbsviAtLYAI-14Ek:;w•et,a!
Land not exceeding 1 (one)acre immediately •14-12aitlItitV-72..11c.P.,1;1.1-t tir
surrounding residential improvements. (1) T,./ Itreilital-irt4..4.-irttti"- '
Other land (2)
ectrtflriWt42.11ThlitYll
Total land(line 1 plus line 2) (3)
2:474;1---litx)rx 141.4TraW32KS*1
Dwelling (4) -12•TaVieliaLe-tat%PiA
Residential improvements
Garage (5) IxPitt-OW(4. .xii...t1.4-a..
Other improvements (6) .
Tctat improvements(line 4 through line 6) (7)
Trial 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
illpaSt-AittaW0flAtraealgarn.STANDARD,DEDUCTION ALLOWANCE"t5:Y17,114,Cia-tnegt_ernI4::
20 Pay 20
piQ\ Lesser of 1/2 Homestead \
Valuation or$6.000 \ \
Signature of Auditor
tK,Q,K.G...) +4- -AA-a- Dati je ion,
et .....a
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