Mobile Home_Lashbrook 4 .1- s CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR iv/' HC10
1"= CREDIT/STANDARD DEDUCTION nA � �
''ma�y_;�.'., I,
` =j Stale Forth 5473(R5/10.01)
°. Prescribed by the Department of Local Government Finance -
INSTRUCTIONS:See reverse side for filing inst 'u s. \
' - . CERTIFICATIONS •TEME — . -
MAR Qq pQ9
I e) I _-• I / // - certify that on the isC1la?HPUarch,20
I(We)occupied as o ri principal place of residence the following described real property for which a Homeste 'Properly Tat Cree�dii'is hereby claimed:
❑ I(We)owned ❑ Are buying under contract /� `✓,41J`}
® � IBSr11',1 ,07-w iii
�(i✓•iave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the prop2ny or is�trying�LlSd Tfkf tract.
�..-"�,s�.''Sgtc:F?:-at .. ..-fn``.t ':r. r '_;:i'i'ICONTRACT=.RECORDED_-`..;L' xtr+--:Y:-,•..47 a`:» ._._:.: ',__ . ._ : . _
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
--.. r sC •t�c..v - •-z.,s", _t,k ,4 c *_':,-PROP.ERTl.OESCRIP,TION't? At'Et^y 4'..+11W-,. •YS- :v.ci-:' i pt _i
County Township T ng slr 1(city,town,township)
•a•-I n ber L';',./.405-..
0 5 Legal d-scription Is the property in question:
kiO 1 I • ❑ Real property W Mobile 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 us and portion
of the property utilized to produce income.
.. --... .. - - va S Zte afc,:
':1r:K0r _ ,t,,5' ,m.rd�°4 :��`Y`'-? PROPERTY OWNED BII'CLAIMANT INOTHER'COUNTIES+., . =, �e+� ,.f?<L -. ,'. - .
County Township County Township
nature o cl nint
I hereby certify the above statements are true,correct and complete. Sig�[/1 J
i umber street,city, -e, IP c e)
L 1111 1/4".• • \ _ A/+/ /l . • . . n_ i
a.y F?72., 4,;. � :'a:. H>t s'i't+- TRUETAX r ASSESSEDVALUE 'HOMESTEAD L.! NON-RESIDENTI4141y"'
r714 ASSESSOR USEONLY fi; Ta?.+? -w �4 -.VALUE i 'AT100%OFiTTV .;'.VALUE7Y; ,: VALUE �▪ . ebt
Land not exceeding 1 (one)acre immediately (1) Sri��w: ,4 , M1. t _=.I
surrounding residential improvements. -- S.-._ i -' r
Other land (2) rt, .ya-:. 3
Total land(line 1 plus line 2) (3)
Dwelling (4) r c?r._'Y. L .a..�:,1:z-▪ 3"S`d;.�Y
Residential improvements p ,2. s t' > Sxs.'r�d '
Garage -i% - -
Other improvements (6)
/ 1 1,:::::21::::1- 94V-;
Trial improvements(line 4 through line 6) (7) 1� `11
Trial value (line 3 plus line 7) (6) ��",
■
N ` !
I hereby certify the above is true,correct,and Signatu i;• lessor �` I L gn �j
complete.
Verifying action-Signature ofrurditor r Date signed
I, r1AK u ti 2002
t,
_'�1 -� .� _' r . i,... ...,�iffit -si,-`•.IL-4p.47 -1 _ST•`+s ARD.DEDUCTION ALLOWANCE _P': t'•�S.,yv.At r1 ` ti y.II.:.1.(, _ ,� ..
1
�... 20 Pay 20� ` ^./ �\ \n\ GIBBON CCU ` +,UGITOB
Lesser of 12 Homestead \`,+� \�' I j \\
Valuation or$6,000 "
Signature of, ditor / Date signed _O
. � � • 3
A an '
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