Mobile Home_Clem CLAIM FOR HOMESTEAD PROPERTY TAX / FORM
CREDIT/STANDARD DEDUCTION I/// HC10
"■. - State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
F ILE
r.----- INSTRUCTIONS:See reverse side for tiling instructions. ;,)
�,,,,p��''-��Tr'� ._ yCERT1F.ICATION STATEMENTA.;,��-."r 'n� - %�'
Pt DI, 07 cuu
I Nye) ` %a A I'_ I ; '' At* ceNfy that on they st d of March,20
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tat/ r t is hereby''daimed:
❑ I(We)owned ❑ Are buying under contract J�J�UD`
I®I ^' Have a beneficial interest in the entity that is liable for the roe taxes on the roe Cthat owns COUNTY AUDITOR is b
, fy property rty property rty and that owns the property or is buying under a contract.
W o'i iR'°r�'a l a a "MAAW- S; 'x€CONTRACT RECORDED" '` - - #°
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
n""� E'�''+'�.fF '�$°'».,:ia 'c�".9w.•t,.t,�stes�.+:e�.t-��-�a1PROPERT:Y;DESCRIP,TION�f.`�aT,'�3�.vY�.+f: �7.a�o-�. -,�i-,. a�}a"�=`��^°''`�7h,ii
County Tavnship Taring district(dry,town,township)
P. •( y1���"r � Legal?Mir? Is the Property in Question:
`sS `I p � 1 `•' Y , ❑ Real property ❑ Mobile Homo(/.C.a-i t-n
If any portion of the residential structure or the land not exceeding one(1)acre that im y surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
`='a 1'``+"'k .i a"° ` P.ROPERTY,ZMNED.BYCL''AIMANTJN OTHER`COUNTIES, ,''. 'ti-' `°,r^y=ja--3t �'.`-o'�w°eM'' tnen
County Township County Township
I hereby certify the above statements are true,correct and complete. ignature o Hi
al-
Address number and state,ZIP Cade , _40 e A /A
'�; r4ESSUR I1SE ONLY -; TRUE TAX ASSESSED V/LLUE �+,HHO�MESTEAD NONaESIDENTIAL
.a=v r ,::..�t. `rz's - s.. �_,.�. 5 VALUE 4`a i:ATt100/e OFTTV, ��V et.?'k¢ 11VALUE'af{s�`sY A
Land not exceeding 1 (one)acre immediately '1"'F rat,l st4 ?'
surrounding residential improvements. (1) � 'y . ' ; rt
nY sW }?KY` u
Other land (2) t u .`"
sE�+aY.wTb
Trial land(line 1 plus line 2) (3)
'. .4-1
Dwelling (4) inn ., t�
Residential improvements or Annually _
Assessed Mobile/Manufactured Horne Garage ( ) e�aC^ 4 xi s xs=: 7
w �' \ \ `aka'w '3.,Other improvements (6) \ t..to-; 77 -
Total improvements(line 4 through line 6) (7)
Tctal 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
� r�i:zt'at�vl��vFrc77a. �''r 14-`, t4.'�9�, .�.STANDARDDEDUCT ION'ALLOWANCEgtaLinsa� �; -�"i�'�':�?'• _�iL.V a*it `e%''r
L/ l 20 Pay 20 \1 I(� n
r�\\ Lesser of 1/2 Homestead \ \ 1Y\ `�I �1
�l` Valuation tx 536.000 \ 0
V
Signature of Auditor Dat signed//�/
,�/ fl h-03
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