Mobile Home_Knapp 4 °= CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
'.. j State Form 5473(R5/10-01) '
'O� Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. 1
-I e) _'j1 ' :`;,..? / C CERTIFICATION STATEMENT - -
I(We) 1�v �k' rti tit on tit �strd of arch,2 - i
I(We)occupied as our principal place of residence the following described real property for which a Ho este r e is ereby claim& :
❑ I(We)owned ❑ Are buying under contract MAK 20 NO2
® 4ave a 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.
V/is9zaa *_�aC '_ei: -.e >' _°"+7. ..;CONTRACPRECORDED;'c: a / �n1INT
YAIDITOR '1. . -
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
t±<_ '{,' X;X:: .4: _ ',4,s. V:9;CI, : ` :i' ;;:PROPERTY.DESCRIP•TION'%! .a. ,l:;:K" _.1- ,Y:?` -T . . - .
Coun Township Taxing district(cif, w ,t ship) rl
P1 . umberr 2 /'�— Legal description Is the property in question:
.:0i-00301— 00 ❑ Real property 'Mobile Home(IC.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.
/9?i1 sJc.iLt, l
t'`h'y v.- -,Wateka- ' , :4? ,BPROPERTY.OWNED BY CLAIMANT IN'OTHER'COUNTIES'- ,iv -_;tar - Xt;F,.r 'kJ- ^47g .
County Township County Township
I hereby certify the above statements are true,correct and complete. ig ure o(S aimant iaj
A. __ - , a, it
gir dress(number and s ity,state,ZIP code) y
r— al / r ' _ 0 . J/ '.. f a I
t ix A£ ASSESSOR USE ONLY - ��r. ' *TRUE TAX ASSESSED,VALUE 'HOMESTEAD : r r r"
,l NON-RESIDENTIAL
.�u� Tla r,.__r4 .,KS;. , ._._--a a r., VALUE AT 100%:OF._TTV VALUE,s t ��r r VALUE .f* _ .
Land not exceeding 1 (one)acre immediately I il " _
surrounding residential improvements. (1) _ , 'sr 4
4T
Other land (2)
/zr_
Total land(line 1 plus line 2) (3)
t
Dwelling (4) 1' ;. £. ..r.;i="' 9"/,
Residential improvements 'I }: r:-
Garage (5) - -1(1141' "�zi` av - -.-
Other improvements (6) _ _r_f :=t..-..,e^.
Total improvements(line 4 through line 6) (7)
Trial 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
411 '-;) -'° `s. lq-IS "ttel :. . Te. <,'t- STAN DAR D.DEDUCTION'ALLOWANCE• :i,'"a y. _.a ka Kiny :_i= .,. .
/ 20 Pay 20 ``y
�\ Lesser of 1/2 Homestead \f\\)14Y \, \�
/aluation or 56,000 `kk (\\( )
S' a re of Audn,r } D s, ed