Mobile Home_Flener ?> CLAIM FOR HOMESTEAD PROPERTY r,
ERTY TAX I FORM YEAR
t•`, :41 CREDITISTANDARD DEDUCTION HCto
'T State ram 6173(R817-07)
Presabed by the Department of Lo®1 Oatemment Finarce r•
'
•STRUCT)ONS:See reverse side for filing irutnrc6'ons. l� ,.
1 999
• • . • /I n' //^ CCEER[TTIIFICATION STATENENTf -
I(We) /`.L-(„ 7 V `-r 1 F I-to y. o .r-.- curtly that on the 1st day of Marc,20 . .
I(We)occupied as ow principal placbjof residence the following described real property for which a Homestead Pmpepyraac C ereby claimed:
❑ I(We)owned ❑ Are buying under contract - ) - , COUNTY AUDITOR
Have a beneficial interest in the entity that is liable for the property taxes oft the property and Beat owns th61 }Ny or is Wying under a contact.
' ' r � CONTRACT RECORDEO� ' ' ' -
I!twine on contract Fee Simple wmefe rm - /
Racrea !d'necort+a is Record number Page
(
• ---- ` - PROPERTY DESCRIPTION
Township Taring district(ay,town,township)
1 Is•ii
:,, .number ,Legal description 1 is the property in question:
cis ariii Lai caul :1 ❑ Real property ��Mobae Home(IC G1.1.7)
U any portion of the residential structure or the Land not exceeding one(1)acre that immediately surrounds that structure is used to p ••• -Income,describe the use and potion
of the property WSmd to produce Income.
airatia-44-41RT-579771-8--9-1-57 97 ci Aloe.)VS(-16_(----
j• - . - PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES - ' - "
County Township County Twrnhip
I hereby certify the above statements we true.correct and complete. �IG^J re of fmmam
fX_) /�OLrr�/
s(number end suee4 o7Y state.and ZIP cods) '
res
//Og3w r
aSo 5 o .. er../s v ; (C 7.1-...._N (-l-7(0(vV
r TRUE TAX VALUE ASSESSED VALUE HOMESTEAD NON•RESIDENTlAL
ASSESSOR USE ONLY
- I ! AT 100%0F TN r _ VALUE- . i • VALUE •
Land not exceeding 1(one)acre immediately ,-sy` i • 7;5
;,...c - l u :t rrtsurroundi g residential improvements.
L' .> . x
Other land (2) teit11ey�*
Taal lard(lure 1 plus Fare 2) (3)
Dwelling (4) s^4y1:1 i 5& ki J;
Residential improvements a Annually • ��y-p/ ..
Assessed Mobile/Manufactured Home
"4--:31)14--i-2\L/S �%""� 'R �._.•
:4-yiti
Other improvements (6) �/
bat improvements(line 4 through line 6) n \ (7) uI CjC"D ,
Trial value (fate 3 pas Ene 7) \` (8) eli
•I hereby oerti(y the above is true.carted,end Signature ofAseeasor 0 `, cry.Oar)
compile. *',^ �•h�ly
IVaty'xg edbn••Sgrtature o1 Auditor �(,J lay.Yaw)