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Mobile Home_Hensley CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
at CREDITISTANDARD DEDUCTION HOW
State Form 5473(R6/4-03)
Prescribed by the Department of Local Government Finance
•
1 INSTRUCTIONS:See reverse • for tiling instructions.
_46-__- •t 1 •Jl1_ .. • _ •
3.". x-i °? */.' _il - Y'3r' -:CERTIFICAT10. .STATEMENTr."3y ; '1. :a5 {C, r� 3 A 4'W ?',zxao -
1(We) .� ■� ��I�� tr \ r �!};0 anon the st day of Marcch))20
N I E-. 4
I(We)occupied as our principa\.lace of residence e f•lowing •escribed re:I property for which a Homeste-. Property Tax Credit is hereby claimed:
i ID (We)owned 111 Are bu• inr•: -. ract F E B 10 2004
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.
/ ( r /) ' 11
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M-�ii-t••ra t^i':r`-•raa�3 ::,'l.,y t. r:_�^t'-.1;Wi:, H1i" iCONTRACT.'RECORDED-_�v. -Me - - '�". _.
- �-.-x?'1.:�F;:R e91�LVl�titi T~f:s�4?3t\�''-='k:`Y+T„a:.�:
If buying on contract,Fee Simple owners name 4
Recorders office where contract is recorded Record number Page
feat ` .,' _IMIY tcM4r _la41--tati e'iii.r9.. `12..ROPERT,Y;OESCRIP•TIONg17- t3v714.43_a _o'.t.$``r_-�`` ..-C-r -id.tt•.'t-t9x 1.�- ix`
County • Township Taxing district(city,town,township)
Li a G
P cel number LegfrOpec1np ,�q� �/,/��yf'� Is the property in question:
N00315.00 ' / ) 1 1 1 / \ 0A r ❑ Real properly Mobile Homo(I.C.bf.1-7)
If any portion of the residential structure or the and not exceeding one(1)`aaare'th�at immediately surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
3?420- • -20 'a t4 I**s•,£.-� PROPERTY OWNED;BY CaIMA NT'IN:OT HER`COUNTIESIstt- .s ->i`ef?m' ?k.'r . 2,17. gy'}s{a
County T Township County Township
I hereby certify the above statements are true,correct and complete. S> of dajpxant
(idress(number and street,city,state,ZIP code) `N�p„�
u
Co
}_ i . Ira . AASSESSD.RR S ONLY - 10-X-4.S'` ALOE; icy AT 100%'OFTTV mss--'e , E O� ANON VALUE- '��'�"��
.se' .._. a eYAY.. ? Ladtt �a.. .s_rte, E'S
Land not exceeding 1 (one)acre immediately a " � < ari e.wsurrounding residential improvements. ` ?
Other land (2) '_i "-)
Total land(line 1 plus line 2) (3)
Dwelling (4) t�•T41s i ¢� Fea.,.fr '.
Residential improvements or Annually - -�.5;'
ci
Assessed Motile I Manufactured Home Garage (5) ii§rr�� s 4
E :85 ..f 4
Other improvements (6) s;� --. : ' a
Total improvements(line 4 through line 6) (7)
Total value (line 3 phs 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
' :�' ?FUG- W c.'�.^mi3 -., a i= l -m si .�7.'A";rt ltW ertar�? .'`hf .z..2
�'��� :.STAN RDDEDUCTION'ALLOWANCE,.k�
/�\\ s Pay 20 \[I \ �f� (1
Lesser of 112 Homestead \\J k�I 11
U� vauauon or 835.000 _ \ VVV••• 1 U
Signature of Auditor /--"y ' " Date signed
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