Mobile Home_Jones (3) x.: CLAIM FOR HOMESTEAD PROPERTY TAX % FORM YEAR
• CREDITISTANDARD DEDUCTION / HC10
:,,,-3/47,__ / nn
State Form 5473(Re/44 3) `
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. G
itIt T a1, '; : tzrw >h-a '%CER_TIF)C 710N t MENTrw i"'>* ( a ;_z _..> .ir?"c *- .:ti:?:.":.
I(We) a //r./ �// it"
/// / a certify that on the 1st day of March 20_
I(We)occupied as our principal place of residence the following described rea •roperty for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned ❑ Are buying under contract
4 Have a beneficial interest in the entity that is liable for the property tax- on the property and that owns the property or is buying under a contract.
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'�TM�.��- "����`ml`c��'°.-�zWy3,:3-`�-'T.'ei:i�^.#�`.t�3�ia"-°?�'.z'3�CONTRACT'RECORDEDz°'." . ''--VY.-:.< i:' '<a�� :�F�yVei.�°,ix��',`_.;:.x'"..,...`t
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded ,. —ReIIy cord number Page
3it-4--% "+ E6. " kg l A. I °'Set-( ;7 P.RO ERTYDESC'IP ���- t '4tvi r ;M 't.7 :ile A
Witi
County Township T.' :Pr (city, Ym,t N
P. • nurr//Q���ber ' l Legal description Is the property in question:
a - 0 U 3 ti ❑ Real property ?Lk-Mobile Homo(LC.61.1-7)
If any portion of the residential still re 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.
- .• -.k6 to,•
� �`*aa�.L�t. -�: yaSTc _.. -`.-.i3 �'� � -.��'_-a'. .-rW��L
, �- '- �,�.PROP.ERTYOWNED-:BYCLAIMANTtINIOTHER"COUNTIESFt:,.,_._.=
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and street,city,state,ZIP code)
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Et. S'i"'T'' ;;..-c'y;>"fa`i as 2�''r ,r L -12 ,- -. .-y"+.. -:-+v^ • q .e. ,
2 SSESSORiUSEON'Y.t--s`r 7 ).'*.rit UE TAXy -ir ASSESSED VALUE HOMESTEAD '� NON RESIDE TIAI. txP .et
k. ∎'tt=a ;na tgais^.��• :.4105ia,W._'fy.'-• . :.VALUE.v'l xAT loos FiTfV2 VALUE. �i'*ia. ..VALUE.n:sa t-449,4.
Land not exceeding 1 (one)acre immediately Mt-14 Tre '�"'* " ' ;s,
surrounding residential improvements. (1) fi ti "g ffri+'^7at'e�r`
Other land (2) Cs-'' :
- Taal land(line 1 plus line 2) (3)
Dwelling (4) t �� r w a
Residential improvements or Annually
•syp
Assessed Mobile/Manufat fired Home Garage 5 '^ # y;c *'
Other improvements (6) .,�-.
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 pits line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Dale signed
complete. \!!
Verifying action-Signature of Auditor Date signed
sx ,T*-"�° s ,?� ` igSTANDARD:DEDUCTION'ALLOWANCEt T" t"` ^1''"" [
"p't:�".l- 1.hVia�'� ,d^r�r�'.zb§>' fcNi�`a3"SF`4.-�t .j"'�.`.`-. _ ti...-.�.iFbk..^.Yla;�=�,z��n+�> �-�i •�r..Ti'�+�-��f��r,3
® 20 Pay 20
(�(�� Lesser of 1/2 Homestead n 1y \�ArV valuation or 535.000 `JI,�1 s �\ �
Signature of Auditor Date signed
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