Mobile Home_King (2) m., Y
a7, :�.,.t CLAW FOR HOMESTEAD PROPERTY TAX FORM
IW v YEAR
0 li i CREDIT/STANDARD DEDUCTION Hc10
\�-_/ State Form 5473(R5/10-01)
•bw Prescribed by the Department of Local Government Finance �].�
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INSTRUCTIONS:See reverse side for filing instructions. /0 �UJI
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Wr"�Y e1�YY!;."--z:,•*"x va"s+ t,rw.-,� f .`-,r :.z.�.-.-.� .. _y i .. � ., y<f_
e «. :LFf�e -5,.t olt s ;CERTIFICATION STATEMENTa v,y._e� �" 3, -..r.. x�,4f .21 piplia,y . %-
I(We) 1� J ..I s� �✓ certify that on I�A day v�'LU GC 20
I(We)occupied as our principal place •+ esidence e following or 'bed real property for which a Homestead Property Tax Credit is hereby claimed:
, e)owned ❑ Are buying under contract ...qt./fr.
�Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the pr erty or'is and ad!
L GIdSON CO Y UL',tun I
: ::` '=c YW: ,;:°"_ .13Gs"" 4V.A2?'.r`s,ar;714 CONTRACT)RECORDED=: scW..s' Aga } igtat-: irai! :`'_..:..7.
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
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.'.'aggi : 2 ar.N'fr=a'i -�5 �'t l '- sr r_ I# it ' ..1r-�-1
: iis':. �` �,`�.��'m'�' °3 .�.'.?P,ROPERT,`IDESCRIPN�f' *; 9§�'t�i`�� `b` c�`�3 ` l �:
County Township Taxing di t(city, own,to )
r ��All Jl
ber_ /L O� Legal description Is the property in quesurop
1`/�Itlo O JJ ❑ Real property Qffilffitile 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 property utilized to produce income.
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Ki.4%tV?' a PaiSSJ''O.P.-"' r�..._ 4,.a PROPERTY 01NNEb OY CLAIMANT;IH OTHEWCOUNTIES `" Tiel`""` "°
County Township County Township
I hereby certify the above statements are true,correct and complete. ignature of claimant
\('..._Address(number ends f,city,stare,ZIP code)
.'ya"'r'.3g8 Y+'4.`..'=`Y"s ia` E"r:. r = AIWZ: °-'�` `°' max_ Yv 'i v
r .ASSESSOR USE ONLY FS" ., RUE TAX_fi ASSESSED VALUE HOMESTEAD x�NrON:RESIDEHTWL 'iW /
x, kn ,rr»€' F e . i�:4€ 1.�.. '.sY.3� it 'VALUEa..?. rg.0ATv100%'OFTrY,: i.,47..VALUE..,A 0% z7l nVALU W—:,
Land not exceeding 1 (one)acre immediately ` . ,� �;"c.--r4 ts.�l:'
surrounding residential improvements. (1) " .+_ z +h1, il'-=i. ' .,a`F <r
Other land (2) S..rf' _
y °s _a'3'3
Total land(line 1 plus line 2) (3)
Dwelling (4) k4 '7rZt,WIh�t3
Residential improvements
Garage (5) 4-.. � :1 �Lcii3t I n3 .y
="s "e*1%
Other improvements (6) r `S1xr� "i
Total improvements(line 4 through line 6) (7)
Taal value (line 3 pits 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
/����;��- �., ,5-,°`=��`��'=,.tn.�.{'"�g{k���'�.�. STANDAR _DEDUCTION'ALLOWAHC __+..9te�.;'.�a:.+'�,.o..�'�;-�`�? ;r.�.�,:�it�.r_r.rRt�:
+{ \ 20 Pay 20
1 \ Lesser of 1/2 Homestead
Valua'on or$6,000 eA 5
Signature of Auditor , ` c 2 n Da ^eq^■ a W / 1M1Y Y,.