Mobile Home_King •
• CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION DU Y'Et T r,:_a S.,1 . HC10
1 State Fenn 5473(R6/4-03)
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�" Prescribed by the Department of Local Government Finance Subject to linai Lccepidn.,e to r:ansfer
INSTRUCTIONS:See reverse side for filing instructions. �—day E t'+—' U f 't a t
s ±E,xf�� i" aigirrxist ' :75 f LCERTIFIC.1, ; 71
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I(We) •,!� .1 -11trl;►7A r �Ly -I:SON tl rT •lbldt li""onQ1g Tst da ,ot T1,20_
I(We)occupied a ` r principal place of residence the fol al g described real i o erty Tax Credit is hereby claimed:
❑ I(We)owned ❑ Are buying under contract pi
/7
0 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prom:-tor�isbggYn�U01TOR )
:ties, a '4FM^4—'.x , a x: - .w•, -e .f.r s rtt r a;it t? z\ r
-c rx��i' r°.e�ze_ ..t�'v.� i�F`_.i�S`_'�"s�'�v��.`��a'�''�s,�'iCONTRACTRECORDED''^�z.��`ex'��';se't�f,._'�,,,,; z�S.•.,�."..+ �i�'°,-'� �"f�? �% .sy,.z
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
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- J.. -.�.- z.:._ • ... __ -� �L+srr3ia�.�cs�`G�:�P,ROP,ERT,Y:DESCRIP,TION�.a'�'�,�+;.:r'S���'.';*,.`xrrt.�� ' `
County �fyy� Township Taxing district(city,town,township)
••e~i• - -605/1-00 Legal description Is the Properly in qu ' :
I• ♦♦I\ eel properly ❑ Mobile Homo(.C.6-1.1-7)
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.
"WSeg.� fa',-' '' '.a ?ROP.ERTY UWNED BY_CLAIMANT IN;OTHER"COUNTIES ,r '';3 � 4' ?ni iVal
County Tovnshi -Caunry Township
I hereby certify the above statements are true,correct and complete. Signature of laimant
•x number and wrest city,state,ZIP code) ^J At - r 9 i A
3 art. 3,9`G C//JI 'J((`/55 J Ij/l,//llv/J!
f°` .t"imin tari 5 a TRUETAX* � ASSESSED VALUE ftif ESTEADys iiTtaESIOENTIAL 6 T?
il. ..a SOR�USE ON ta -• ' VALUE ' .'. - AT,k700Ya OF�Ll1V'y�L- d:LUE � x `+°VALUE tat:
Land not exceeding I (one)acre immediately KijAnerkar 'p
surrounding residential improvements. (1) 1;24S 7
, S,
Other land
(2)
Trial land(line I plus line 2) (3) +5� i�
Dwelling (4) s " s s `E.4
Residential Improvements or Annually 0 ( ) + t�.� �r.:riix-ty
Assessed Mobile/Manufactured Home -gp�-'-�' T i--1t r+ ;� , '`Y� -~g. '��:
Garage (5) - �� ���t� •� �
5'� 'rwtr fY
Other improvements (6) 9
Trial improvements(line 4 through line 6) 7 SEP 1 J ?C14" r
Tctal value (line 3 phs line 7) (S) nt:. ,✓T
ORSON C "1. AIInITnR
I hereby certify the above is true,correct,and Signature of assessor Date signed
complete.
Verifying action-Signature of auditor \ , \� \` , � `i '� Date signed
� °"! tir'^ ;y.r t _*Las STANDA,rARU:DEDUCTION' ''OWANCE<I- .r" 3" - _d.:.- 1.. :;y-' I - a-...:-5
> �'."$4�'�c`4�a7:"�rI!�i'2��`L�.°_-�ra.T.�i7'�u*n; _ _._ .�sk,.�elL�._�i_r3: .•.".«^zS"�.t.�� .'�+Y,. '�a-"rd•.
\ 20 Pay 20 _
�` Lesser of 1/2 Homestead $
IValuation or$35.000 iii111 T
Signature of Auditor //J V - D lied /.. o <. GO
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