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Mobile Home_Biel 0 CLAIM FOR HOMESTEAD PROPERTY TAX - C1O YEAR CREDIT/STANDARD DEDUCTION HC10 State Form 5473(R6/4-03) Prescribed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructor's p 71- 1 ) ' r1 � 4 ,s- tra: ggi: 1= / • 4F- ` =n KCT C {CRT)FICAWN-STATEMENTi's t?�a.'T'S-yt5 -i->3?E';i..�; �.1's� `.—x4t VS ,'i_'r vw `. I(We) / / I,. 4/t. --.. - y certify that on theLl s(day of Ititilla 20 I(We)occupied :-our p`''pal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed: ❑ I(We)o :• r ke buying under contract i / ' ' �/J (I Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope'rijbdis buying'undert co pe c.✓�-. " .s'editG aiii�T .% . .: ec'.,ra'z_CONTRACTRECORDED ailatv3 ;, 'e. .. a'' c { If buying on contract.Fee Simple owner's name Recorder's office where contract is recorded Record number Page r ,,:-�:. ''- "v - •w: -'b� '���'-�'n��xs''_T->y aP,ROP,ERTY;DESCRIP ION .'•v<;�'S'�r;`vFS �..f,;.��:.�'z�"r `•` -�.I-. County Taw nship Tax g �'' to ,townshi.) Parcel aY..y L al s tion c eg /oa f Is the PropeW keaJ property�� > -�as Jr='{„/0 /9�Q � � Real Property ❑ Mobile Home(LC.6-1.1-7) If any portion of the residential structure or the land not exceeding one(-1).aae.ttutimmediatety'wrrounds that sWChlre is u 'produce.iacwne,describe the use and portion of the property utilized b prod (I,- ' a rFROPERTY,OWNEDBY CLAIMANT,IN'OTHER"COUNT! A= ",,,y."tt'1re `•rb�i .492.{s County ---------.______Township 5.ouat Township I hereby certify the above statements are true,correct and complete. i9 turdaimant ress(number and street,city,slate,ZIP code) F h/1` • 4'.P4/ ?e, x / i i - e zat-e,._t€ ., ih. V 76 7 A r . .r `ter ' 'i�as1.- 'r?" t". .• STRU SSEDV• ;;•-1.k - s ,•W F ASSESSO p yeti ONLY` fri g � .E a . 3 `.,-. '�NONtiRESIOENTe a..x• �rzTi3� �:$'9sS:�S&'?_'zk...':91'.;.��-� �%�,2.�?"+i ATz100%.OFTTV�&�V�r.-,x...'. `��a`r�IrVALUE� °t.•�"�� Land not exceeding 1 (one)acre immediately V1 " ` � > R surrounding residential improvements. 'f •✓ Other land (V6 /6 1 g a.,72 �•4 Trial land(line 1 plus line 2) (3) o'6 - - 7 - 000/9 -G Residential improvements or Annually ( ) .:ra.�t` t - 'tea- t Assessed Mobile/Manufactured Home Garag: 5) r i - -t� d ter1s I'a_` :: rK Otherimprovements 6) +i. , a Trial improvements(line 4 through line 6) (7) _ t Trial value (line 3 plus line 7) (8) I hereby certify the above is true,correct,and Signature of Assessor Date signed complete. Verifying action-Signature of Auditor Date signed ` ® anT" mare- -r° �"_ r`STA 1:1:DEDUCTIONALLOWANCEgr$iz fAairn " "� �L ZA:c=: "3� r.43�' 20_Pay 20_ Lesser of 1/2 Homestead \ ,y 5\`\h 0 11e vauatlon or 535.000 Signature of Auditor - Date signed