Mobile Home_Foss •T::,..
; -12•:,1 CLAIM FOR HOMESTEAD PROPERTY TAX
_ FOJM" "Ord YEAR
CREDIT/STANDARD DEDUCTION ? ILH,C14::5 i 1
c. : . State Forrn 5423(R5/10-01)
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Prescribed by the Department of Local Government Finance tat
-----' INSTRUCTIONS:See reverse side for filing instructions. t
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CERTIFICATION STATEMENfl . rm. • ci-_..:‘, ., ,-,:l .Z- '. -: 4_?;,.....- .,
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I(We)_CI_L(12 cif;dyattlet cs.ii uldt'clatof March,20
I(We)occupied as our principal place of residence the following described real property for which a Home teagiWerty Tax Credit is hereby claimed:
fl I(We)owned D Are buying under contract
gp,iave a beneficial interest in the entity that is liable for the properly taxes on the property and that owns the property or is buying under a contract.
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W4Leappilciu*N72nmartImti.:".L.:43:714,c,itc-;CONTRACT?RECORDEDt:thri`Itit-4,:;;, ..-4P,'•
If buying on contract.Fee Simple owners name
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Recorders office where contract is recorded Record number I Page
;_tiE,Z;;;71.1-,- ,5inaiiirStiiia5W-dc-i,,V4gWV,n5;:.1.1:R ROPERTY.DESC RI RT I 0 N krtFi544:::::514:&14 iV., =1;42.?..Y14.B"'214.4rti Etiiiiitii"tri';177t-it 1 ttiii iii'-
County Township acCiinstrict(city,town,township)
Parcel number Lk.
a i- Lezj\destription i. - CriN_T
Is the property in question:
'41,ic,v—00 5 Occ -co \--lath:MN rb,-.1c D Real property lid Mobile Homo(LC,6-1.1-7)
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.
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County Township County Township C !
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I hereby certify the above statements are true,correct and complete. Sign of claima
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loress(number and street,city,state,ZIP code)
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Mm :ia•- •iita-'•-l=:a..4"..i.SuraASaSwEASwS4O7--21R,4UA-StE-ON--L;YkEt:cbab zi.-3511f 4 .',..: . A...;.Sil..al°iA.it.P C FAA%lTE- s'
i*4 gt- *.4S,:-ft h tel.a,fri - Er-44 A- w.ax.4 - ,
APaVAYE-N. 41% !PTYaa441X z VAIu ?
Land not exceeding 1 (one)acre immediately :V(4130,(Wint‘it.:VM44.1.,.i”
surrounding residential improvements. (1) Cl't.iti:kc,P!"-*S;(141a1:::W4fri:":'
7!,..:Ivir,41,Ronej-g6.-4
Other land (2)
Taal land(line 1 plus line 2) (3)
Dwelling (4)
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Residential improvements giretaiglaitttS'Igai
Garage (5) "4 latia°
,--Fri, 9, s--k
z.,2.1.troatri,g-t-ccAft-ra-,-,,
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Other improvements (6)
Total improvements(line 4 through line 6) (7)
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Tctal value (line 3 pks line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor
DiacVigned
complete.
Verifying action-Signature of Auditor . bi)/ Date signed
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411/rWAiP.iWEr'Sfig:SaikViarrai-Liniif.fSTANDARDDEDUCTION'AISO vt:31et ' sri .43zeorsf,!gor-s-49cosa-t=3:
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1 alik 20 Pay 20
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LI Lesser of 1/2 Homestead
Valuation or 56,000 5 \ t \lb\A \\\r) \Al\
Signature of Auditor Date signed
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