Mobile Home_Byrns ?� CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
v. CREDITISTANDARD DEDUCTION HC10,.,
-711 . State Form 6473(R5l 10-01) r 6
Prescribed by the Department of Local Government Finance •t
INSTRUCTIONS:See reverse side for filing instructions. a
�- 003
��� ®"i ���',�'_�� �" :�3"7CCERTIFICAiIONSTATEMENTa ,ils' t_-^v".. �^2.i- -i.�,):' :�:F. i: i
I(We) MIL ' Y .M01 �+� Y r 1
certi at on the it d�f.Ma 2(1
I(We) •• upied as our principal p -ce of residence the fol.ng described real property for which a Homestea 7 rty iaxer 1 it is heiebydaimed:
❑ I(We)owned ❑ Are buying under contract UU G1-'50�Cva, .
0111 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.
' e"''rn..n "..r a.ja,.? -.4-..;f.:.`"::,$-;•'". tCONTRACTRECORDED" .a- ",,,`- at " ?. ,r- T! ' �'-1'--�.
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
rwsw m`z c .?s•n ?,u�_ . ' • `srw aa,-,1 PROP,ERTYa itSCRIP.TIOtiW agiaeis-L-'--.?,swasa`,�'X i?` .•1 . t i
County //11 I o To�wnship lacing district(city,town,township) —
rcel umber U0
Local de criptioQ\■\ Is the property in question:
--Co. R� b V..! CP‘\ ❑ Real property EKAVobile Homo(I.C.6-1.1-7)
if any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to, ••u i•••me.
qtyli/S -_-_'
"S.••■ e' "
*Cs' 6- 4ece1� g��= ` >�� y
_S>aAlra-% -,tatPROP.ERTY,OWNED:BY CL'AIMANT--IN'OTHER`COUNTIES u.a ar'r.��'..�.,,-�•x tt4pa
County Township County Township w
I hereby certify the above statements are true,coned and complete.
Si�ture o(dairga0t
Address(number and street,city,state,ZIP code)
Sit re `'(�_
l(4111 3' 3: t ! ate.,..
y - TRUESAX''�- ASSESSEOVALUE ` HOMETEAD • pNONtESIDENTAL ''
i.-„i. AS$ESSAtnr ONLY < - t VALUES; ! 4T.x100°�'OFiTTV �'-. VALUE ; ,W -s
Land not exceeding 1 (one)acre immediately rt
surrounding residential improvements. (1) -- gs s °k " f
Other land (2) ,. c°
Total land(line 1 plus line 2) (3)
Dwelling (4) t ftit.. .
Residential improvements
Garage
_rat^. �.a ^'"
Gara a
(5) ; a
Other improvements (6)
Total improvements(line 4 through line 6) (7)
Trdal value (line 3 plus line 7) (8)
I hereby certify the above is true,coned,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
rM etlpvlt ?; '.`STANUARD;'DEDUCTION'ALLOWANCE sent - fWiax � aZa a
- 20 Pay 20
(X.0 Lesser of 1/2 Homestead \ "1 '
u- Valuation or$6,0
\ \� ` `I��
`S�pa�'ovre Jof/ud'' _(S `\\ Date signed