Mobile Home_Henson •
"R.'. YEAR
2 CLAIM FOR HOMESTEAD PROPERTY TAX FORM (/�,
CREDIT/STANDARD DEDUCTION I I / HCto
`` �, State Form 5473(R5/Department I�'}- (I// �y 9° Prescribed by the Department of Local Government Finance
iy) ,� 1
INSTRUCTIONS:See reverse side for filing instructions.
r'=. '•_; : ?_. s; .its r ;•_unit -i:. .tCERTIFICATION STATEMENT:r ? --„" ::):41 .
I(We) ► •!'S i _ .tat_� a.m. certify t ton th%.�M1ay of M:1 h,20 (
I(We)occupied .+. our principal place of residence the following described real property for which a Homestead Property Tax Credit is he :r. O- "'
❑ I(We)owned ❑ Are buying aV
(W ) crying under contract '- •
®Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prope .r'; • t
(-10\S\-
ttder a contract.
G�8
I
%=,4 T - '; ,iv.c-o,,,k-Ti!., =:-a;mS: CONTRACT;RECORDEDKa --ysa S,,,v4t:-_
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
sx�- '"r It ie a _.n 7 _ 3rs_• 5M7i3� ry�..4 . _. ftWEI74:° t:4 a-t. .:z .a3,
�.... --r_ _F __:wr»,..�....r,�t+'�c .y-.y �rr�__.'F6 ._ PROP.ERTY:DESCRIPTION<r�'.--r .:-t_. 3€�."a -.�' �,.�.,.�.. .
County Township TaC dhistrict(city,town,township)
,,• -I umbeerr3/� t4 ,i - Legal description descrip}�n n n Is the property in question:
'\�,(& (J✓1 CO - Ca 1 e l5 J�-. R- �7 . r 1 ❑ Real property ❑ 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 properly utilized to produce income. 0/00 a-
e y W7-i _x$, _i.PROP.ERTYAVJNEo?BifCLAIMANT,IN':OTNER'000NTIES+'`,`k. t 1S.IMI -;��..'i,.; r..`a ;fkr.tf:`l
County Township County Township
I hereby certify the above statements are true,correct and complete. ;nature of cl i ant
Address(number and street,city,state,ZIP code)
z{ -'rteairMi'''' -" -''ig tti ` ' TRUE TAXfli ASSESSED VALUE r NOMESTEAb y sT NON-FtESIDENTIA 161.*
„ ; ASSESSOR Ure.tZ' iPA ,r,VALUE'-- AT 100%OFTTV ? VALUE""dre �3 3 07 VALUE s•A '
� :..im"� 1#SST.�v� _ra a~~d �3'., . ¢+r _ x..§'- W _,. . . r,�,r.>!�.,-.,, .,,�. _� .x --y.�a �r
Land not exceeding 1 (one)acre immediately k r�,1 "t's1 1z ,
surrounding residential improvements. (1) w n>w r�yn
s } 2724:•Other land (2) y,a s z$1
Total land(line I plus line 2) (3)
.1441.- h ll ig.7 ' ri
Dwelling (4) ri 2 f� : , r
Residential improvements
Garage (5) ;'�c�-Rv ,: ` ' 'ttia-� .
:i .�.n1-jt' F Ya.' g ..
Other improvements (6) !sx"1?' ,;+�+
Total improvements(line 4 through line 6) (7)
value (line 3 pits line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
�Ee r�=�4 ��� : fR" „ ?Zf�'��'�_ STANDARD;DEDUCppp\\\N:ALCOWANCEt oS �a- u:�as-r3 fi-:�" .1,:a.-..-g)-.:
;
20 Pay 20 \ > \� 1^ ^
(��..11,��� Lesser of 1R Homestead ,` (JD
/1 ` Valuation or 56000 � Ni) 1
Signature of lJ r /) / ///n/ Date signed