Mobile Home_Cousert 0 CLAIM FOR HOMESTEAD PROPERTY TAX 1 FORM YEAR
CREDIT/STANDARD DEDUCTION \&s. \ _ �`NC10 1 ' iA
State Form by (R6 Department ` \ •�ad rj is t� !�
Prescribed by the Department of Local Government Finance g -'�
INSTRUCTIONS:See reverse side for tiling instructions. AP R i a
.._ .,..-� �.-.�^+�•`' L
004
_ _. . ^, ' aEtr .c.a - K�CERTFlCATON STATEMENTpe >r ^"tr � a-4`
A°n"°/1 _
..{., ,.., l v7/w_l�r_,v
I(We) C s��9 1l -'�-��_a Q\ certify tFat=oh'the'1 ay of March;20-
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
I(We)owned ❑ Are buying under contract
1 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 undeecontract.
Alta l-i. `-rcer a r ti.CONTRACTAECORDED1 W4--;1.4.7910 Y rti .I -1,-,S A r'. mx:
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
-.:. .nalta` s-:t.-," .s „; P,ROPERTY..OESCRIPTION$; .?,4;`¢�+a.ef,�`�'�-� ra�•.k`tt+:w-�'r���t .,:.
County Township r Tadn district(61%town,t hip)73 n. 1
rl/Wl/O0 F'1 .
(Pa c n bee`rrt2 Legal description I Is the property in question: ,�-,
-] r 0 " a O ❑ Real property [ obite Homo(LC.6-1.1-7)
Warty 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 produce income.
Cis l e � , •
K r 'tette PROPERTY;OWNED`::BY'CIAIMANT IWOTHER IN 70THER'COUNTIES-egalViNgrAMS
County Township County Township
I hereby certify the above statements are true,correct and complete. Signat aimant
1,,1�
�P dres�(numberand shoat,city,. r- LP-y 23 7 � 4 . Li) ( `( Ci
`�-r-`,° `4 a- `k-rai° `s>' Fi TRUE TAkt- D VALUE HOMESTEAD NON-RESIDENTU\L J
ASSEes R 3E ONLY` , : 134 - ' AT 100%OFilTVya yIVALUE3'+�' #.s ii,4
Land not exceeding 1 (one)acre immediately '+Av -,T-'s y:.^
surrounding residential improvements. (1) '“- ;4 4 4 'v'.ea ;
1 1� li.z�'2 -�.. l%
Other land (2) ; ,
Total land(line 1 plus line 2) (3)
Dwelling (4) ,� w
Residential improvements or Annually � -"�- rit `-
Assessed Mobile/Manufactured Home Garage ( ) a '"ir rrl-` ,
9 5 � ``�����,yy��yy��uujj S �w
rft C
am}Other improvements (6) e .t c
Total improvements(line 4 through line 6) (7)
Total 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` nTErarg r_•-' r :-y Tura
�- �rT„�.„-tf�iia�� a ��;`.STANDAR�:DEDUCTIONIAL'L'OWANCE, `f�� t- '^�M' el eg^
4 20 Pay 20
Lesser W 1t2 Homestead \)\K}).' ���\y� �\ \\(
Valuation or 535.000 ,\ ``
Signatur of lwditor mo ' Date signed
. —