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 ■ - -r 11— _i ---