Mobile Home_Hale (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
• ✓ CREDIT/STANDARD DEDUCTION
v` State Form 5473(Re I4 03) 1
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Prescribed by the Department of Local Government Finance ( ) -•
INSTRUCTIONS:See reverse side for filing ins:ruclions.
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DI(We) • E r, ' , ` `"a. certify at on the-tyo�f Marcl�in
I(We)occupied as our principal place of residence the following described real property r_.�:•� a Homestea rapeRpjTax-Credd':ts haeby4t-aimed:
k (We)owned ❑ Are buying under contract
ye ave 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.
rf �z•rxL -SYs'Y^�S"s."s lVI '- tPa,'`r,.`+fi,.;5§` gtr!CONTRACTRECORDED 1 ,MI s?r;r``?•,." '.r ' :"..:a-e .V-tn , --s;:;5
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
-ezie—t r :, �4'"_r PaC. �..srr-mar:!F�itar :"'yLl'clP.ROPERTY-DESCRIPTION'F-tirS3iji4Yn„fa ugAt4'y,.c'- 'a' W}. i�s'.htVni�,_it
County Township Tarim dty.town,township)
tR�`'cell n�umbern-� lko,I- Legal description Is the prone question:
�t ) l J�$(.-R'-' N l � ` Real ro
p perry Wle Homo(/.C.8-1.1-7)
H any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce income.describe the use and portion
of the property utilized to produce income.
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s-:i:taailz���-'�3-rai*.�'�d�v`•."'•z-: -",_ irYPROP.ERT.Y,'OWNf_DIBY.CL':AIMANTAI;OTHER:COUNTIES '�•'�.-.�.r_VW�,-�4,_�.>rgs?.'• ;m}? iA
County Township County �/J,., n Township
I hereby certify the above statements are true,correct and complete. Signature of claimant rr`I(�-K v
Address(numloer and street,city,state,ZIP code)
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it • ��- ,>e=,•a:�^. Tom: ,_ - - _
RUSE ONLY��-� TRUEATAX�'1'��. ASSESSEDNALUE *HOIdESTEAD� �NON�ftESIQENT'IAL
SS# ~ . ' ?� ':a:+<r.: 1kW L VALUE-t . °' ',fitTtOM/:OFii t$ r.o-T,`�y-.4UE `��n�3(,t:I.Y/LL,UEt,ci..Y�,avv...;;G
Land not exceeding 1 (one)acre immediately 0741: r � K
surrounding residential Improvements. (1) + s fiur y 4 -
Other land (2) .�rtx ±s+�s_Z
Trial land(line 1 plus line 2) (3)
Residential Improvements or Annually Dwelling (4) < � `t attgee}V0
Assessed Motile/Manufactured Horne Garage (5) y ,y ',.tfr F"�"tair°�t`'�'r
Other improvements (6) �s+��,t'
Total improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
((�a «{ 3C-n rr-D>'-`Nzsi>' Ft3t`}`p 7��.rf Si'ST/WDARDAEDUCT)ON'AL''COWANCE n`"",; <. r- t) q4 'c'
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20 Pay 20
3
0 Lesser of 1/2 Homestead
\A ll mon or 535.000 \ \t\ \\ (\
Signature of Au• • ;, I Date signed
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