Mobile Home_Cooper 1"t`r CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
} CREDIT/STANDARD DEDUCTION / HCID
State Form 5473(R6/4-03) v I
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
3't` -LVAF , a "` 4r ?`° -TIFICAON STAEM (* " x cY �' vig.:!n`: .ye:.
I(We) _) A 0
A-Al 1 slab* •-ICI ttbhyyeat q the 1s day to M r ,20
I l %(We)occupied as our principal p1- of residence the allowing •escribed /1 property for whi a Homestead Pr. pe y T edi GIs tier yr ned:
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❑ I(We)owned ❑ Are • 'ng under contract 4 qq Q;
l Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propor7 buyRl�tnder a contract.
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/ U f/ Y
�t �t �`�" caS 6CONTRACT!RECOR DED v}�ss '•V �. �a �� �
'TI x '
If buying on contract.Fee Simple owner's name v
GtgSON CO UNT
Recorder's office where contract is recorded Record number Page
;=F =uniF. t:1t-:„r �F- --+r?Wa,-.v iP,ROP.ERT.Y:DESCRIPTIONV.„ .i-s'�„�� ._ r.c_ � -�'I� iN,IISgiYe:
County Township Taring district(city,town, ip)
fr Par cal pu f'�` / Lag d ' hy'o I I Is the property in question: , • /
ur�5 OrS l V /�l P'-'/�11� J1y�}I,'Q�rte(^ `L�21al property ❑ Mobile Homo(LC.6-r 4j
H any portion of the residential structure or the land n exceecing one acre that immediately surrounds that structure is used to produce income,describe the use and portion
of the property yl�utilized to produce income.
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lejA `A tea- "a - W D --_ J a `Y'"' hY" tt,;3
�u :-�.-�3t'2�,'>5�}54`«s, �r'�.: F?ROP.ERTY,OWNED',BY CL-AIMANT;IN OTHER"COUNTIES�z,_.�°"��.� �,.,.��_,�- �- �,s�'?=e
County Township County Township
I hereby certify the above statements are true,correct and complete. Siy re of claimant
_ _j 0. Phi
d number and street,city,state,ZIP code) /
•y 6 2 4 Q/,v-e/YL4,7A 4 TP4,t ! N...Ph . 4,7 e 6.5-
7 _;,. ASSESSOR�USE ONLY' -x- ?c; RUETAX ASSESSED VALUE rHOMESTEAD -T} ;NON;RESIDENTIAL YW
k.i `I - ,rsi. d::; ,,..,... :�-f'` ,VALUE:' r.-t.;AT4100/a'OF,TTVA aVALUE.tr rij t, i-VALUE .s;'
Land not exceeding 1 (one)acre immediately 4 `' F- t 9
surrounding residential improvements. (1) t ny°3- °
Other land (2) ' 'r
Trial land(line 1 plus line 2) (3)
Dwelling (4) '-Crse �._ !,nrfx,t—
Residential Improvements or Annually '`;'`° _ "'°
Assessed Mobile I Manufactured Horne ,ai -tat-)
Garage (5) _,
- . _;ue'; `
Other improvements (6) '` '` r it-,
Tctal improvements(line 4 through line 6) (7)
Tctal value (line 3 plus line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
®`v r" iw� '" T�,�y ` 'i STANDARD'DEDUCTION'ALLDWANCEe1 = .,y x'ia"aa`-,.'.va+' )�_ .o-t-�szz`-rTg�' ,;,:
\ 20 Pay 20_
Lesser of 12 Homestead 1�U
vatuason .. 535.000 \� 4 \
Signature nor / AO
Date sinned ---Q3