Mobile Home_Boyle CLAIM FOR HOMESTEAD PROPERTY TAX FORM 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 instructions.
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.S y.�4-.4 •"" {�' r - ;i ait;CERTIFIC_A_T_I.O__N STATEMENT= yq -M I;'r*x' tf* -z— .5
Au�:3�+� ��Jr ard�6'Z�:Lil>��Ti�}���'.� T ' _ - �1�.J�aY13S,�S ���y',��� {).° ._ _��h.etff..!ar
I(We) , \ ' Icertify that on he 1 dtr of March,20
I(We)occupied as our principal place of residence the wing described real property for which a Homesteaddtdr{lerrtty Tax redit is hereby daimed:
❑ I(We)owned ❑ Are burying under contract (4 a 0
te Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or iss"'bluyirig4under a contract.
bJ� r,VJt lL.r
,�. i� ls his.�' ss'Y-�'e� �e."4,l'�r�.-. .ti..,''-f3CONTR.4CTRECORDED�%- 'a�.�aw °`.."�:'�'� �es?x .-��-t�,: '-,�"w„y�•,,��€
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
Pit4c-''c 'ar,><,s..,e. Errra't __-`s. a, 'T <',fir ^'`._-,�i` ,'!;:al P,ROP.ERTI,OESCRIP.TIONP. -`.-9;�s+ flr¢aT,n.F. � ".;a7,- `Arra n:
County Township Taring district(city,town,township)
CO i{,o,�p property in question:
'ar;/ -umbe CO 37.a) Legal I� I ^ Is the ro ❑ Real property ❑ Mobile Homo(LC.6-f.1-7)
If any portion of the residential structure or the land not exceeding(`on'ee(1)acv- „^/at immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
&erIT r3 PoAl mv"."'
P, ,”: r' 'le r d-:*: `aseROPERTY OWNEolittI ammANT;IN;OTNER`COUNTIES ct`c�-:'a rtimi = 1ZS.I'1P{s
County Township County Township
I hereby certify the above statements are true,correct and complete. ig tore of claimant
Address(number and street,city,state,ZIP code)
Y"- 'A ll N Y . -fix. - "l�'RUE TAXI ASSESSED VALUE HOMESTEAD t INON-RESIDENTWeS
. ATT100%O-TTV y::VALUE + ay,' VALUE, .,t
Land not exceeding 1 (one)acre immediately `° -"r ''" F .#s
surrounding residential improvements. (1) R �,.g�ig4VI ;.
:as �.r a
Other land (2) ' ?r
Total land(line 1 plus line 2) (3)
Dwelling (4 k"s' ~,'y.,,4� n3
Residential improvements or Annually
Assessed Mobile/Manufactured Home Garage (6) agr - , ...--MLA
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Tdal 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
� „ i k jie STANDARP;DEDUCTION;AL'LOWANCE t :?fly,, , ReAd_._s ?;� x„a
' 20 Pay 20_ ,1
Lesser tin Homestead \ \ \\ $ \ f� 1.1 I `()
Valuation or 535.000 JJJ "l\ � l b 1\\ YV
Signature of Auditor rji24.4 D ate g` 0,3 W