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 ) '
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,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
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,,:-�:. ''- "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
