Mobile Home_Dill t+ CLAIM FOR HOMESTEAD PROPERTY TAX (�J FORM R
F + CREDIT/STANDARD DEDUCTION j� 1 HC10
�� State Form 5473 (R7 i soy
Pmsuted by the Department of Loral Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
L:'aV€5flTTtU..)•
i(We) t ' C C)CM certify that on the 1st day of March,20 c
I(We)occupied as our principal place of ' ence the following described real property for which a Homestead Property Tat Credit is hereby claimed: •
®I(We)owned ❑ Are buying under contract
+W 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.
tr�'. :.: ',C i 1'-LItIYi tilti>tnP is ran ".)7ifr r'fi W'k.+ a„II.$CONTRAC.T-.RECORDEDI.(;n''.'`"Vx."c','( .:K�"u'':'.rnr�.:: .- .;11.4rm'ai �'7S's��' 11y`:r*x�i=
If buying on contract,Fee Simple owner's name .'.-.^
Recorder's office where contract is recited Record number Page
€ al+ drni`aKi.4W°"'ariiY'-kle• !1hC. ..q.f,,.°„ati sI:PROP,ERTY:DESCRIIMON�. "if,.c y.h�yys`,v :r v s. . Oyu $: r- g j£-x`dyK r- I
roi,r- 'N , . ., i,.,..:n 1,�3�ys'.S:'l ,s.Y+f;t�if?,.+S�,s{t-L.�'':.rc. .,r a-rt� a,a.:
County Township Taring district(city,town,tornslap)
(L e�� scrippian
I Is the property in question:L oobws t/ LboV r+skeetinfikt
❑Real property ❑ Mobile Home(/.C.61.1-7)
It any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that saucture is used to produce income,describe the use and portion
of the property Wired to produce income.
�Ft”'`'¢i°_+`titr`�`':)'1f?;c;{te�. ttThv z'-t�'.*'.-va PROPERTY,OWNED BYCLAJMAN 1'IN OTHER'COUNT1ESji�.§u�''�?'!';�v' aalli�i'.-'fww'�..�%rt1r'','�,^}4v
County Township County Township
I hereby certify the above statements are true,noted and complete. /\/\'�Signature of claimant
�oss( & sfreel,dy,0 LP rode( ) n_ 6 % •1 47(o o
,.y , .tI�KIS ORUSE WaLY y 'rfOt �v1(7�*t"TRUE;14;il`e{+°` ASSESSED VALUE ?.SHOMESTEAD;;r*'� =t"NON?RESIDENTUU. ii'
o`�#k,t Lta7w A3x24g?n„wsa dti :.:*a.4- ":....t.VALUE of c°yC� sAT 10Q%OFfTTV� '4..X VALUEtc'"a l 9"s.xkt, s 1`?',VALUEx:4, { '.�.-.
Land not exceeding 1 (one)acre immediately (1) ' '+�y,.. rry-><�x,�.`����?y,�,5 ;_
surrounding residential improvements. lift r ^ur-aa.,ty rv,: l'�Y'
Other land (2) x Inn 4V ice:
Total land(line 1 plus line 2) (3)
t " `Y : Ii L>Dwel6 n (4)improvements or Annually �_4NcIA SITIP •. ' }.
Assessed Motile/Manufactured Horne Zar a 'e ,�a
Garage (5) tf7 Yh'
Other improvements (6) 3'f ' *r-wl;ti'1 i!df(<
Trial improvements(line 4 through line 6) (7)
Total value (line 3 phs fine 7) (8)
- I hereby certify the above is true,cared,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Data signed
4 11) \- \\ \%?C\Q®Bpi.T '4:2,:r�`,74,S `_4girN""e4.Ca'' .._ ,J.,-,-,!=STAN DARD:0-'UCTfON'ALLOWANCE-;'>s1 £f`/,r��rE'`-°.hr ys�v!H. r�'t `3'....a'tt/MIA-: 'ff' _`�
20 Pay 20
( "�\\ Lesser of 12 Homestead •�,y, E \�\\ 0
'(\� Valuation or 535,000 �l V
Signature of Auditor a / pate sg=ell/t so 7