Mobile Home_EdwardsI%
YEAR
67,1,,Lctb CLAIM FOR HOMESTEAD PROPERTY TAX FORM _
49:1,701a_ l . CREDIT/STANDARD DEDUCTION F, r --HC1o4--1 -,-
:i State Form 5473(R5I 10-01) _ r�
Prescribed by the Department of Local Government Finance /'
INSTRUCTIONS:See reverse side for filing instructions. [�///
MAR
,s- r. • r ,r. -�, v - 7 2003,-�
c.,� a »;�`�� -"'.. �'..t..Ai''''�1'� t��.. � �CER FICA710N���ST��ATE��MEI1NT_�rr •71M n',�Y, '" ';3^a..d�n,�`4"�'.;�;,,r*' yitr�:
I(We) / (/Q certify thaton/ihe 15if day of-archn 20_
1—r-v_-"-•-'ii fy;ire s ham!r
1(We upied as our principal place of residence +q • •swing described real property for which a Homestead Property Fr Credt is hereby claimed:
;Ji�vn
I(We)owned ❑ Are buying under contract
alHave 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 ziliii.c Fr .`y71 4;315 -d� rer a C ONTRACTIRECORDED.ir=e"s'' , ;ta' ,2 : 4 pr_
If buying on contract.Fee Simple owner's name
Recordees office where contract is recorded Record number Page
sy , ,th 4 +1 3 .'. ,1.1PROPERTYDESCRIPToN aiii 'd vb✓ z . k
County
Township Taring district(city,town,township)
P r 4a0, Leg a scdption Is the property in question:
''GO a v / -.col irr,, �. / e. ❑ Real propeM bile Home(LC.6-1.1-7)
if any portion of the residential structure or the land not exceeding one(1)acre that im iatety surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
/9 9 Co mr.
r. `sMiaM 14—Ca*>' P,ROP.ERTY,OWNED BY CIAIMANT;IN,OTHEWCOUNTIES1.s ;Vii " sex?' €!SSfF'"°
County Township - County Township
I hereby certify the above statements are true,correct and complete. S. ure of daimon ,/ If E
Address(number and street,city state,ZIP code) yUf(//
^ t t "`y -- s' .HVL,�5n"'zz 4`'fq ,i -.:.:ri --°s ,try:
ASSESSOR USE ONLY ' "� TRUE TAX ASSESSED VALUE s+HOMESTEAD^" NON;RESO)ENTIA
---:;,:ii.-..;. :SES Fia .vr: rte.. - s' YALUEt ..;;..':AT 100%_OFM s fiVALU nat Yeiliugiate, - c:r Land not exceeding 1 (one)acre immediately WC W*,.c ,`- 3 '
surrounding residential improvements. (1) _ 12,V .43a„`, 7
Other land '. - "'+' sr
Trial land(line 1 plus line 2) (3) yS
Dwelling (4) " °.+r a:. V:t° , .:kt
Residential improvements
Garage (5) a. ;_ c`- '�r rs
X
Other improvements (6) i y�
Taal 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
iigtZts�.,..�-#eraa'^�Saviara .�.,;ray'{,-.-,STANOARD: EDUCTION ALLOWANCEeeaWa�z,:`- "�,�+•'AVIgth`'..tu,'fia�s�"[�?aI�L'�'6?;�,4�N
IIIII 20 Pay 20 I
ftft Lesser of 1/2 Homestead \ \ \I�\` $ \\ \' \I \`r
Valuation or$6,000 l J ` y\
Signature of Auditor Date signed