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41 b CLAIM FOR HOMESTEAD PROPERTY TAX FORM Nn YEAR
i . `,►i. CREDIT/STANDARD DEDUCTION HCto / ,• \
�:"j State Form 5473(R5/10-01) V1
"" Prescribed by the Department of Local Government Finance
® INSTRUCTIONS:See reverse side for filing instructions.
fty s J ''i' r ,':Atr t:Iri ` :.CERTIFICATION STATEMENT w_'F `-sr;F - -
I(We) //s.L____.4 St � / i di chapq on�th d-, of /:rch,20
I(We)occupied as our principal place of residence the /flowing described reaalproperty for which a He)- -stea&Pre{le•1gy 1�e.if . -'-reby claimed:
❑ I(We)owned ❑ Are buying under contract F E d 5 .2002
-• rave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property yor is buying under a contract.
s�Viis''"'.{v .sayt"..n,„e.,, -wit Na s ct-Qi/ A...z.p,-Tath c1 :CONTRACT.'RECORDED_ia<•:, � rIACrIAI ( : 't�t / - - .. .
If buying on contract.Fee Simple owners name -- TOC4, \"
Recorders office where contract is recorded Record number Page
- . _ .. • ti!„a? i
: v x i;:p . ov. s1 �« .a-Vill,,r:a tt.5.P,ROPERTY,DESCRIPTION 51. ;I d��tcas w . ra s zF' '
Country Township Taxing district • n,township) 6-
Pare nnumbber 5S-Do_/'�� Legal description Is the property in question: II
I O f—oO /J ✓ ` o ❑ Real property Mobile Homo(,.C.6-7.1-7) 11
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. U
-.,tr,?,.z='&PROPERTY..OWN EIIBY a emMANT'IN.0THER"COUNTIES f Willi- ` n-,-i`' F`Ot1.
County Township County Tovns`hip
I hereby certify the above statements are true,correct and complete. Signature claimant
Address(number and street,city,state,ZIP code) �l ..4./ gt--/
' AASESOR SU E ONLY �'.� t-.. TAX s ASSESSEOVALUE e-HOMESTEAD , NON-4; v4-'
lta,. 4f0 z_t cc--r.�-... �?t=c�yt,4 ; ri VALUE'., . :AT,100%.OF11V , r:s... .VALUE i ft. _,t t:..s,',vALUE't r.--1'
Land not exceeding 1 (one)acre immediately �:3 ,�4r.i-rte+ ni r-% .{.�,,,
surrounding residential improvements. (1) '�' s- . �3,Tx - {_.`
ii-Fi : s tali Other land (2) f ' 74-
Tctal land(line 1 plus line 2) (3)
Dwelling (4) xs$k (� . a ,
Residential improvements y �A-�-• �?=•r^1-`�'`= =`>
§ - 3
Garage (5) , '; ....'t` ,-1- Ii Fyn!
( ) iiR
Other improvements (6) ==:� `'"-”
Tctal improvements(line 4 through line 6) (7)
20 'value (line 3 plus line 7) (g)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Vaifying action-Signature of wditor Date signed
`alWAV .laW";a�a"*e"t;pis3il jai gc `tla TAN DARD;DEDUCTION ALLOWANCE f.-Ma¢"`x a ;} °' *•tom„'°,,,
\
20 Pay 20_ \ \v n
ie. Lesser of 1/2 Homestead \� s . Iil \1 0
// U� Val non or 56,000 \\o '1
Signafl/re pt Auditor DateyOned., -
' U(^Jt) IS- Da-