Mobile Home_Dillard •1743',, CLAIM FOR HOMESTEAD PROPERTY TAX FORM Iltral
)f l CREDIT/STANDARD DEDUCTION HCIO
c �_y Slate Form 5473(R5/10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
R-'�T.,rt.1:41IVe°tS'.4ra;,1aesa11 ??M417e ;ryERT1FICA • 'STATEMENTS?Y-Okrica nk-Gr,4-,4�y-.4°yl;rF;c`'fq'r�`--� .
(We) CO .Iv I• ',Win". �'{�1y t
I
� ) y� c lit on a 1s�T''//of 1l{i 20
I(We)occupied as our 1'nctpal place of residence the following described real property for which a Homes P rt fia(C�ditls - y claimed:
a•I(We)owned 11) Me buying under contract APR 2 6 2002
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.
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•••s`-it ro a t e,_s `w. --,."z�.`.'a'^ : e- ��?s':�'•>`.i. '.F1s". ctINTRACT;RECORDEDIA BOG: ` �°Jit zu,.., —,
-=e1.„..(;IRSrTNlrnf.r, ntlrtrna n-.= t a ;
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
Y-ti=tal- atr .tsa—nl`��' 3'�'i�'ma§�.��';T` flP,ROP,ERTY;:DESCRIPTIONN airfaRR�� ,e., ^� "'�'� "�`. 1
County Township Taxing district(ci ) `_ �.. .?�;: +a:�_' i.s.r-
1;1-v ' QO® /A0 Legal descrip' 76.-- larrivitthe grope in question:p Real roperty obits Homo(LC.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 income,describe the use and portion
of the property utilized to produce income.
^•;F411*i4',?vt.,� '�.t',a�-�`taWPROP,ERTY;OWNED'iBY CL''AIMANT:INOTHER"COUNTIES�.,�aTak5•$g' lflT'rYt'`'
County Township County Township
I hereby certify the above statements are true,correct and complete. Signa ure . . .- ^• /1
r V�dree uaber aM stre4tete,Z e).. `
K,. Z � ` '�`=x' IS + TRUETAX I Tk ASSESSED VALUE HOMESTEADk NONrESIDENTIAL-
x " ASSESSOR�USE ONLY
�.•ri.`:� �?9�'.at`,fit4��-mat:.. yt` �.ry0aYALUE .�M,�'Y� : T�700%.OFMTTVh�3.�VALl1Ey.-:..'G��.wx'.L:fi'..VALUEl t�:,�°,�,a-.>:
Land not exceeding 1 (one)acre immediately 1 k.,,,, aQ+ T +4 _ t..!A
surrounding residential improvements. () ;_ 1..? r'4 r,+` •=e ' 1
Other land (2) �
Taal land(line 1 plus line 2) (3)
bDwelling (4) rh a:S t Residential improvements
■
Garage (5)
ro,r-
sgli a-,...:4741.,- t '*. a'4 ` z
.1T-4 f
Other improvements (6) *-- t;-� fl,
Trial improvements(line 4 through line 6) (7) '
,el value (line 3 pits line 7) (8)
IV
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor
one[)
t H'k,' a' .. e �.'-:tF`1T' n . re-i� ?`; ',”sTANDARD:DEDU TION:AL'LOWANCEY_" -,..x• "y.",-
_ A z. _
20_Pay 20 $ \ \\\�
�\\ Lesser of 1/2 Homestead /
Valuation or$6,000 • //. 2-
Signature of Auditor //� • / GIRRON TDvt � Y/ — a