Mobile Home_Burke ��f'' CLAIM FOR HOMESTEAD PROPERTY TAX V FORM YEAR
' CREDITISTANDARD DEDUCTION HC10
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'-!!P. State Form 5473(R5/10-01) ! T^, t �
Prescribed by the Department of Local Government Finance
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INSTRUCTIONS:See reverse side for filing instructions. r�{y
,Y .. ._:.ate ,ry;. .. , i s gCERTTICATION'STATEMENTF ,WS..i, `�Y+�;,-,- 'r 20.14a
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I(We) [.(/I',C.C�Q 13/4 !f esid wing m iJ�that o the sl T i -March,201)
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I(We)occ as our principal place of resuden a following described real property for which a Homeste u IAUDIT y�datmed:
' GIB ON COUNT v AUDITOR.
7?). I(We)owned ❑ Are buying under contract
a Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a contract.
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A.'.°ZS' u.' w; n.tor.iYar CONTRACT RECORDED'ti`...�+i� lr- N:. -,.. tSiI.-. - ,`", 9,
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page
.-.--„:. "4t��a=�-ffl�.3afs' �-��PROPERT;1(.OESCRIPTION2 `- - ' �i' .,..- ate- '�is',��' .w'4 _ ' reas. -��
County lit/ T Taing dss ' �(dfy,ttawn to��vrggssshhh
I number // /� /�7 lion //J// tea 4 Is the properly in question: `�(/,"
j 66/Of " 0 / X//d U a// ❑ Real property 2.�wblle Home(LC.&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 to prod/uce In _come.describe the use and ponn
‘,
of the property utized to produce income.
-s,.. s.. - �-it70 p'"?ROP.ERTY;OWNEDiBY,COMMANT.iNN OTHER"COUNTIFFS.FL:-ag6Cr':'} tigaa
County Township County Township
I hereby certify the above statements are true,correct and complete. Signatur of claim nt
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th (numfmr and t.ntl:state,ZIP code)
. ,efZI L CI 4) traineiscr7 .J N Li ?/ay,
t •- � ' '411. . F ` !a ;TRU AX ASSESSED VALUE. HOMFESTEAD }NON-tE ISISDENfali e
ASSESSORUSE ONLY
. `._ °? rs5i "`�'-,• - ±- '! VALUE.ts.. 5.ATt100WOFgTfV VALUE§=a tiovAtium .- -.«-_.
Land not exceeding 1 (one)acre immediately ( ) '�`"~t'�.',c�R. .qZ'
surrounding residential Improvements. 1 " g
Other land (2) ;S'�, r_
Trial land(line 1 plus line 2) (3) •
Dwelling (4) 'k $c's -,f '-
Residential improvements T ` '¢" .z '�" - -
Garage 6 . _r,3; 7
C"?.4-• '.'mss 36'r'Y
Other improvements (6) It ///
Trial improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (S) .
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
ite ms-' 1c ,iTMiR,,'`' ec:,•t-.a,STANDARU'.DEDUCTION'ALLOWANCES •`a.A�" . aaki . c? T. _-_-`aS
20Pay 20_ ^ /
Lesser of 1/2 Homestead 'h/ $ `V 1
Valuation or$6,000 ` \ �\ 1
Signature of Auditor - \\\\\\"' Date signed
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