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Mobile Home_Hart itLitil CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR it '-= CREDIT/STANDARD DEDUCTION y^� Stale Form try Ih Departob) Prescribed fry ere Deper-06) of Local Government Finance I��1 JOtl ,_--- INSTRUCTIONS:See reverse side for filing instructions. Q . . . - .. . . : rte- i CATIONSTA7EYENT:" .� : 2008 / MAY i-;4 I(We) i, -i i— 1 ii 1__..f. certify that on the I )occupied as ow principal place of resideiZniFigffiggitg described real property for which a Homestead Prop It : I(We)owned ❑ Are buying under contract. UN AUDITOR 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 .i. a;•;'. r.',.`.`. •CONTRACT:RECORDED ;r e:t:;;;,..,t,i':- .'k':, y.. . :".,V1 .11,V If buying on Simple owners •.... _ /,(/ /120,4. Recorders office where cartad is recorded Record number Page•1t i/in •- / gyp .' PROPERTY DEscreuPJnoi : '; 1 ,4"_:'. . '•)1 t r x..,c./O . ' .y.: ,'It';w";• Canty del l 66U N Tuwrrship T / /h Legal description Is the property it oration: C�`7( �-0Q 1 9/Ct • ❑Real property �I Mobile Home(LC.61.1-7) If any portion of the residential structure or the lad net exceedug one(1)acre that in eciafely surrounds that structure is used to produce ikorte.describe the use and portion • r 1 c0 Li ;0Cd/146)&/C ,: ... . . .... . .... . ... . ,::'''PROPERTY OWNED BY,CLAIMANT IN'OTHER commas?,.i.)-r • • r4.r...`dr:*Ys t:,34.'.a.r°ttl:g County Township County Township I ,S wra ofot . hereby certify the above statements are true.correct and complete. SY .th n 7 Z SC 13.( *L l t /®teas(number and street dry:state.ZIP code) Y `r Sin L3-- V_)0...uk., 1 ) . te--F 1A-is ci-- iutme 40-12-)Z.+A q )u7 b- ° ASSESSORUSE ONLY. t Ott. :r TRUETAX .AT OF LU t V �""- 3`p� eV "AIR ).... tier . . . ..S b :a t� . . r ,:net 'J.2 . t' ; he'.INr.- aL'r+rr.5d.}-�, Land not exceeding 1 (one)acre immediately Z ru i +dttru" xa k 3d+ q surrounding residential improvements. (1) ya :w/ s° z ' ^Stiti Other land a",Jhlic:?-1...'. Trial land(line 1 plus fire 2) (3) f xr` .0 e` r4,�.1 Dwelling (4) rt , r tT� ` vs V' dfi Residential i npwements or Annually Assessed Mohde f Manufactured Hone r vd�lr�'�` ?A $} 4-ax�1`a Garage (5) ,. ...ii6o 5 iia$11iCtl?aTIM4 r Other improvements (6) rr : Total'improvements(fine 4 ttvancjh Ens 6) (7) . . Total value (lire 3 pls Eno 7) (8) I hereby certify the above is true,correct,and Signature of Assessor Date signed complete. Verifying action-Signature of Auditor Data signed - `" '•� :SUWDARD CTIWI'AhLOMfANCE 'lth ..- ,.cea' %^ _e.0 r?;bS.i U\\ Lesser of 12 Homestead {}'\�J s \I43 Valuation or 535.000 - �\ \j/ \ Signature of Auditor Data started