Mobile Home_Elliott _ .. CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
y'• � Z7?:;fill 1t CREDIT/STANDARD DEDUCTION
"1.1 -`"--'. State Form 5673(R8/7-07) ,rt HC10
.r. Prescribed by the Department of Local Government Finance 1` -
lNS .,w rlu S:See reverse side for tiling instructions. l ' -�-_ t
�'-` ✓'.-.,;1p£ r i ;. s" - ,:.< `- ,'CERTIFICATION'STATEMENT�4 '' f,-+-` :: .. . . •r') "-:
I(We) -� a • � ' • certify that on the pm gpyi4ROQg0
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is herrby claimed:
atI(We)owned ❑ Are buying under contract 727 418
Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the propertiar trait
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_ .. ru _. ., ,- •- - :CONTRACT.RECORDED -- - _ _ .
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
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::r, -� �='PROPERTY�DESCRIPTIDN ',`. l -- • :+!
4nty1w Township Taxing district(city.town.township)
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Parcrl num ���� //�� Legal descdP�on n /�5 the p/r/pperty in question:
(' �V®®Wfi ��c7o e 7 I(/ („L)./(_, Real property ❑ Mobile Home(/C 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that irnmedi y surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
�firl.�lit do— /�'OSe0 —60 d—a?G —i
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Iii- . . Lx, :-'' :-:r 'P.ROP.ERTY OWNEDBY CCAIMANT.IN'OTHER'COUNTIES`., ,' 7 .74 .... . _ ;. "
County Township County Township
I hereby certify the above statements are true,correct and complete. Signnn claimant
0 s mbar and&m et •,state,and ZIP code)
r4lo 4 ' . Rd Ni • Jvi 4i •Yo
g;fxt s) "ASESSOR USE ONLY - a ?.l TRUE TA%VALUE ASSESSED VALUE{•+.HOMESTEAD � I.... NONRESIDENTIAL ,�4V...
., 1 r ' rp.y; r• r ` ° 1t 1 . : AT=100°/ OF.TTV ! - VALUE .f111-7.;,.......4VALUE': i : •1 Ji.3\
Land not exceeding 1 (one)acre immediately :- , j' - I.
surrounding residential improvements. (1) '
Other land (2)
Trial land(line 1 plus line 2) (3)
Dwelling (4) +
Residential improvements or Annually ,... - ?. • .
Assessed Mobile l Manufactured Home
Garage (5)
Other improvements (6) -
Trial improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed(month,day,year)
complete.
Verifying action-Signature of Auditor Date signed(month.day.yeah
,4 _ - l�.'STANDARD_DEDUCTIONALLOWANCE - r- - , .;�_y
Lesser of 1/220 \\44,000 for 2008 pay 2009 - 41,000 for 20110 pay 2012 \� `r (� \'\;\
Homestead Valuation \ F{ �\ 1 istattr or V 43,000 for 2009 pay 2010 40,000 payable after 2012 ,
Signature of Auditor r1 Date ned th,day, err)
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