Mobile Home_Ellis dam-',o CLAIM FOR HOMESTEAD PROPERTY TAX FORM - YEAR
per.. (77}
1 E CREDIT/STANDARD DEDUCTION HCIO 5
Oq `'- State Form 5473(R2 r 5-92)
of
r® INSTRUCTIONS:See reverse side for filing instructions.
I - CERTIFICATION STATEMENT • - .
•I(We)P � �
QJ � certify that on the 1st day of March. 19g3
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
ill(We)owned ❑ Are buying under contract
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.
CONTRACT RECORDED .- -
I If buying on contract.Fee Simple owner's name
Recorder's o:See where contract is recorded - Record number Page
PROPERTY DESCRIPTION.
County Township Taxing district(dry.town.townshp) '
Pa:el number Legal Description on d _ -A .
boa-o1389 00 .. lA}/f,�, (_0
If any portion of the residential structure or the land not exceeding o (I)acre that i vediatey surrounds that structure is used to produce income.describe the use and portion
of tie property utilized to produce income. .
. a '' Qo4- 05-cos"-co .
01/4-73 -aJ -/v- 7o% 319- 6 5` hortadi-r Ay/,,s .
PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES" t -
ICounty Township CounCounty Township
I Ip/hereby ceniy the above statements are true,correct and complete. Signature of claimant
Riess(number and street city,stare.ZIP code)
I
ASSESSOR USE ONLY TRUE TAX ASSESSED HOMESTEAD NON-RESIDENTIAL
VALUE VALUE VALUE VALUE
Land not exceeding 1 (one)acre immediately
surrounding residential improvements. (I) I
Other land (2)
Total land(line I plus line 2) (3)
I
Dwelling (4) _ ,
Residential improvements - -
Garage (5) - -
Other improvements (6)
\Total improvements(line 4 through line 6) (7) V \/' 0 .
value (fine 3 Os line \I(g) I
I hereby certify the above is true.correct.and I Signature of Assessor I Date signed
complete.
LVerifyiug anion-Signature of Auditor I Date signed
a _ _ ___..__