Mobile Home_Hinds na
CLAIM FOR HOMESTEAD PROPERTY TAX w\\ FORM YEAR
CREDIT/STANDARD DEDUCTION HC1O IA
Stale Form 5473(R6/4-03) _� Ti '(lJ1 h �,
Prescribed by the Department of Local Government Finance � ' jf I I ({ ` {.t )J
1 i L-.d S—J �//
INSTRUCTIONS:See reverse side for filing instructions. n
x" r'L-a s goLtt .z�' r iris 3 € 'CERTIICATION STATEMENT r?sui: ✓, 3�5'-"t:R:. a..0 6a a;Ae/�uicacte; ; -
I(We) =i I/ 4 . St& j - certify that no the 1st day of March,201
I(We)occupied as our principal place of residence the following described real property for which a Homestead Propertq Tat(Credit is hereby daiined:
(We)owned ❑ Are buying under contract
" G3SC. ' . ., v.
t _❑ 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.
Dial 31,-.- ' r2. :k'-i55,r . 11 '3 i '�,'�r c_ 'ra CONTRACT;RECORD ED ''^„f`IiTt':Aa-v':F,." -ati.e' ast,'1a' '`i�.'t.`r'%tWe _<'.
If buying on contract,Fee Simple owner's name
Recorders office where contras is recorded Record number Page
is->3^- .""tarn t ^`"7fi. ' i'�i. `:T`rar �.NE -SPI1_" G`'t 1v- n� ':^'�U»'.-''! -c `.? ir`
County Township Taxing district(city,town,township)
Par I nu ben a' Legal description �f✓n Is the property in question:
_ ao S 7- cv 9 [/n pL1Urt / ❑ Real property obil
Me Home(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.
'`' '�- ''� ,.:ltAti!ROP.ERTY>OWNED;BYCLAIMANT;IN,OTHERCOUNTIES Jam.,-,4%6-°�ra' ;,, .SSea
County Township County Township
I hereby certify the above statements are true,correct and complete. S/jtg�9\fie t 1
Address(number and street, l � I�/ '
( city;state,ZIP code)
4
„"` writ �srS a 4 e "- rte ' r h.s a t-,..
ASSESSORUSE ON'Y �w4 TRUE TAX+' R ASSESSED VALUE HOMESTEAD NONRESIDEtJTIAL���h
3'�-a`' r-t£s1cL, '? 'r22? -S4'w1.u:fca Mk.VALUE-�i;) "ATs100%OFjTTf.ViS " y-.,5aALUE.��' 'p _., "»t;vALUEsu...f.' ;d`
Land not exceeding 1 (one)acre immediately W ;. s v°
�r%\_1`?
surrounding residential improvements. (1) Y=� riz y�, �' �
w,1T,Other land (2) i �
e
Total land(line 1 plus line 2) (3)
Dwelling (4) tSLawrt�, r..a- 'g` ' '-'
Residential improvements or Annually #-� A•"^^"-e -�°N'� '='�- '-^�
Assessed Mobile/Manufactured Horne Garage a aw- i ce^" .
Other improvements (6) x4a
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,and Signature of Asse' r Date signed
complete. %
Verifying g action-Signature of Auditor / Y Date signed
+04.1-2 » P.f4:7 35r irte at 'O 'caT--- O DEDUCT)ON'ALLOW C� ' :ss`•.'a Ra+z: -f°jq*cT.' nl�e Fdi4"tiin.n.ci> G
\\ s Pay 20_ \ \� ' , 6 1rr
\\ Lesser tin Homestead \ S \\ \\\\ UD of
vauauon w E35.000
Signature of Auditor - Date signed