Mobile Home_Deffendall CLAIM FOR HOMESTEAD PROPERTY TAX YEAR
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0 CREDIT/STANDARD DEDUCTION
HC10 {. "
Stale Form 5473(R6 I 4-03) i fi u� _Le J.� 1 i
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. O C I ;; ! 2004
, . irL'? i >r �.tr ss-"'`s,'�";s `- CERTIFICATION
S TATEMENT2r^ a> i,? ._k, b-,..°l '-wi'5{`iZ-v ..:. ..
I(We) „ • .\ _ • • . certify diet?on$he,(1 d ytjMarcfi`-20 '
UJ:IIJl-r i■I(We)occupied as our princi a•ace of residence the following described real property for which a Homestead Property Tat Credit is hereby claimed:
(We)owned ❑ Are buying under contract
110 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 under a contract.
? ;.�a` cT 1Mi' =aira#2 :cSAN.r -41-, CONTRACTRECORDEDEkai si 1fikrgEW4a4 : 0: itriZ, � *
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
. c its:. z'^.-.- <rrtrnikaiz` `.t`sS14''��.i�.•�.zqP,ROPERT.YDESCRIP.TION�:+t"�`�'T ik4W-3..t �-'•:.`ca ^��iy��.Ei *},-y€ fi"i?;
County - Township Tadn district(city,town,township)sh
Pa umber b OX TA � Legal description Is the property le-- a:
bO 7t \-/VC ..j ile Homo(W.6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce' come,describe the use and portion
of the property tiled to produce income.
cf.)
rL- a "a"°"ffaW--: PROP.ERTYOINNEU SY CLAIMANT,IN':OTHER"COUNTIteWS€ r x jilt r_. E "f'sr°...a;
County Township County Township A.
I hereby certify the above statements are true,correct and complete. Signature ol�laimanf /)
171-1 )C�GAG2�/( C 41
Address(number and street,cIity,state,ZIP code) �/
®� 5290 tO. u)aintdf�N dal .4-1/ -( i ggr t,/ 11 l/] 70
,,:t g:;--3e4,,c a^a a iet ?'.`:"' ry : -.e 2 i -v r. r-rc;,.
"` .'- ASSESSO_n 3 ON Y._;rte Yr4,F,VALUE^''-L; AT1 0WOFWIV VALUE D �,p VALUE�t* �-�`- -yy¢
Land not exceeding 1 (one)acre immediately ,1.f+ ga' n.
surrounding residential improvements. '&. .wg5 ''"F-., _;:)
Other land (2) F �Y*, ' --
Tctal land(line 1 plus line 2) (3)
Dwelling (4) i - ' i?. � .�� i
Residential improvements or Annually -'�.is'i`+1`�.s.��'i.2h-i:F d,
Assessed Motile/Manufactured Horne Garage (5) j�1- ^*.e "` ' x`f
Other improvements (6) ^
Trial improvements(line 4 through line 6) (7)
Trial 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
W'_ `^.inr�a--aatri".atii'lWWi ,-,-`i,STANDARDDEDUCTION'AI:LOWANCE, x?+ „^`:.... as - v'?;.ri%�' "_;�°i d` :3 ,'''xf i
I 20 Pay 20 l`� \y
�\ Lesser of 1/2 Homestead 4\cly 5 \'')\``` `\\� N\ r
•
Vafuabon or 535.000 _ , 1�JJJ 1�
Signature of Auditor /
31. Date signed b
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