Mobile Home_Caudill CLAIM FOR HOMESTEAD PROPERTY TAX /v FORM Y
• CREDIT/STANDARD DEDUCTION
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s. ie State Form 5473(Re 14-03)
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rescribed by the Department of Local Government Finance -t '1 '7T • —4 U''
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INSTRUCTIONS:See reverse side for filing instructions !1 II �+ ,tf/
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- � _ � Ki -�C. _ CERTIFICA •N STATEMENT > .,.»
I(We) .. •7 _it ... &el riau .. tday
certify that on the 1st day of March,20
I(We)occupied as our prin.'sal place of residence the following described real property for which a Homestead Property Tax Credit is hereby,Caimed:
I ❑ I(We)owned ❑ Are buying under contract ` SO:-i c l`�' 9!TC'1
telHave 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.
r-.ts�',m+rclt• se t4+aure#ig..V- Y, ::-a'yR'fh-k',-igCONTR.4CT'RECORDED_�'-r.-Tx1£te.MWIyar,:z 'c .7.'- -<- tst='*v�.t'+r,
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If buying on contract.Fee Simple owners name �
Recorder's office where contract is recorded Record number - Page
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�c'�� �.�.♦'FfiOP.ERTf;DESCRIP,TION'd�'" .111.1-era. c. .�u�;';:
Coin 'nj Township Taxing district(city,f•sit;: icz?di
�� //��//�� cc a/�/ Legal descd/)��dff� 7Y7 the property quen: •
�W�J �� ( / / [1 ❑ Rear property bile Homo(/.C.61.7-7)
I any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to prod income,describe the use and portion
of the property utilized to produce income.
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fi -aC' .Sit tizit : N. P,ROP,ERTY:OWNED.BXCL'AIMANT,IN ATHER`COUNTIES ,f..,z.<a?i011t+y� 44,,. , ^fi`vS
County Township County Township
Sjg�ature of claimant T.
I hereby certify the above statements are true,totted and complete. / l
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Address(number and street,city,state,ZIP code)
„,o`r. /chi etra', /r..✓'!e -a .& r,c'.
.6,--'W1ft?`Arab � -4,4• 514,5 Virg' > ASSESED VUE l OMESTFJf z � NO�WRESIDENTALea2 _.szRrv,17 r�` _,-;+4v wa,�yVALUE k Va yAT 00/„OF TVw 4�� VALUEN �IrVALUE '
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Land not exceeding 1 (one)acre immediately e italr ,g .� �,T
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surrounding residential improvements. (1)
j: $
Other land (2) 7
trar
Trial land(line 1 plus line 2) (3)\ `o \q
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Dwelling `c \a \` s t ti. k" `�3
Residential improvements or Annually `\ {f�i�e " :E"�`'k"'r� <iu. '�. -
Assessed Mtlbge/Manufactured Home Garage ( ) W0 r.,
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Other improvements f� sK ' {
P 1 \ �L
Tctal improvements(line 4 through line 6) •_Jt\ (y)
Tctal value (line 3 phs 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
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r o- -' 6r r*r ``tritrti -- " I, 'a•' f ar' STANDARD DEUUCTIONALLOWANCE,a •P X} irri .W? : .' 5�,."r7.y;.�,
\\ 20_Pay 20_ IY� r1 ///��� -
Lesser of 112 Homestead \ f \1 $ \, 1 1 . 1� 1,
Valuan 535.000 \ }`( \J1\\ ` II
Signs a 01122 n 1 � \ Date Ted
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