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Mobile Home_Bullock 0``-`,'? CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR -1` 2k CREDIT/STANDARD DEDUCTION HC10 // } cc : / State Form 5473(R5 1 10-01) 1"' Prescribed by the Department of Local Government Finance INSTRUCTIONS:See reverse side for filing instructions. P?= L,t' '-n't,;- . {;: ,S'Y i::-= a- _::n:._+'CERTIFICATION STATEMENT%< ,_. . L�( , jjjjjj I(We) /� � certify(fl{flhat o st day of March,20_ • I(We)occupied as our principal place of residence the following described real property for which a HomehA Pioper Credit is hereby claimed: ❑ I(We)owned ❑ Are buying under contract I/' ®Have a beneficial interest in the entity that is liable for the property taxes on the property and as •- ••ye--4. . ■• • ruder a nuact. ..,.,• .�"�� -+..(.Try. .. /D r`IRC(1N C'C'i v AUDITOR ) 4,45Ziar' .> *s,s`.;. - ...t.:.-.•,e.: .acilt iCONTRACT'.RECORDEDY.,;; 7 _a`.^_Iw1; 2::: :.: ,., 3+'3, . ' . -: If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded Record number Page ._tla_�-0C::r*,`••' �: 7 �•-t `:= xrescm.;��"� ,,,.- —�c �4�...:,�a .. -a• �.. _rs.t_,.,-„1�. .��_ . ..,_,r ...;P,ROP,ERTY,DESCRIPTIDN�-� a...ry G.=. . �..:� .� ��:2,= �y. ..x ,X:::,ix.: County ��l�!�..,,y��y�� Township Taxing district(city,town,township) P •a •her �pAPp�ot�1//�.��`+ Legal description Is the property in question: `xi. 19 ` ©V V W El Real property obits Homo Q.C.61.1-7) If any portion of the residential structure or the land not exceeding one(1)acre that im diately surrounds that structure is used to produce income,describe the use and portion of the property utilized to produce income. y e asa' iaS4 1,{,3€tx L -Fit3:=. W PROPERT_Y.O..W N ED Y CLAIMANT;INO THER"CO U N-TIE_ S y s 3in , . J_t,1'0 tfari. County Township County Township I hereby certify the above statements are true,correct and complete. Sign. ure of claimant rAddge6 ja and street state,ZIP co ) etiiin \' 2 �e ASSESSOR USE ONLY r<-. ` / '+�TRALUE f of ASSESSED VALUE +HOMESTEAD R NON RESIDENTIAL' ke x ' �-..-"..iitc. 3.R'yirSi �.. .AS1��..: .,-1,.t.' t-.r VALUE=�ts.,f AT.700%OFTN< rL.a.:VALUE„s''-. �'�.�-..c�- .VALUE „•,.,_ �-sti - Land not exceeding 1 (one)acre immediately Lz •x n,•"'.r'+ y - 3'i surrounding residential improvements. (1) ri "?fig T +?,: E stt Fv. Other land (2) i`, I�^`b'rs '`,; `- Tctal land(line 1 plus line 2) (3) *r tvy?,f F' -K Ytn}"14r =1 Dwelling (4) =rLCr 5 r r - 7 g`! " Residential improvements ;--sF s : �'5 y >Garage (5) r s V Other improvements (6) "01rF3cc" Tctal improvements(line 4 through line 6) (7) Tctal value (line 3 plus line 7) (5) I hereby certify the above is true,correct,and Signature of Assessor Date signed complete. Verifying action-Signature of Auditor Date signed : 9wn... Ps :,-fat i ilcr?441,,c,-jr:,rST DARD.DEDUCTION'ALLOWANCE .ti Z=5-W y---•z r'91M`avi1 —e.c..e III20 Pay 205 \� y\ �\ Lesser of 1/2 Homestead \ \�� ` \ � ' Valuation or 56,000 (/( /1 Signature of Auditor (A 07 s gjo....0a i•—r2)'.l” --, .