Mobile Home_Lott CLAIM FOR HOMESTEAD PROPERTY TAX FORM 1 _ YEAR
CREDIT/STANDARD DEDUCTION HC10
' State Form 5473(R8/4-03)
�- Prescribed by the Department of Local Government Finance �� � � f.� I ��
INSTRUCTIONS:See reverse side for filing instructions. 1I"✓, --�'JJ
i ' `',rr",' % `r-�- '`'.' r'" 'ttyWaccRTIFICATIOMSTATEMENT:,# e "xr AWAIII(i- "V42003# " ftAi
I(We) St s 1 r a iat • certify Oiat on the lsl:day:Of March/20 /1
I(We)occupied as our princi 1.I place of residence the following described real property for which a Homestead/Property TaxCredi4Is hereby claimed:
❑ I(We)owned ❑ Are buying under contract G5S0t4 CCJ.TY ALI5ITC3
f Have 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.
`[a-.ts'._.r. ` jat•rsY-:`t' vint " �t r- wiraCONTRACTRECORDED" s2 aS;tnealk_ -" °','d r.a': :at-,
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
#'- - '._a4 ratan ' <✓ zy.- ,sTs^..r.. ROP.ERTY:DESCRIPTION .? .- . ,tFAwsstw•Iz #-s` as .e'=.
County \t Township Teeing district(city,town,township)
P /qur er 4Q)i'` ,^ Legal descri ti�{ ^ H +� / ' Is Ih roperty in question:
byY r0)C PP1{tM{ 4 �(�Q/L /( ❑ Real property obile Homo 6f.f-7)
If any portion of the residential structure or the land not ex mg one(1)acre that imme•i-ty surrounds that structure is used to produce income,describe the use and portion
of the property utilized to produce income.
W`%.,'-''Mai'earalf? all%'*` .- iNkfI ERTY OWNED BY CIAIMANT;IIJ.'OTHER000NTIES .tCerISWEr' ftte '_'.
County Township County Township
I hereby certify the above statements are true,correct and complete. nature of,plaimant rt
Address(numbe sheet, state,ZIP code) nC/'
® . 3 31rc'. pnld ) .4n�#71o70 /�,�P� aucr let.221
't ` '� C �' TRUESx ASSESSED VALUE f HOIdESTEPJ -s NONRESIDENTIAL 4 r
ASSESSOR USE ONLY _p *�+- �. '
:r as•A'SsgiZniT[,a<iss0 'k-t �.aM ` .VALUE ':`ATz100%e'.OFroTTLV-ns >r v .17141 _. st:.3',F.VALUE—15}_ .-%1
Land not exceeding 1 (one)acre immediately ( ) t Rte. : .,rz'-w4* -,g "
surrounding residential improvements. 1ti' ,
Other land (2) nrl - k
Tctal land(line 1 plus line 2) (3) -
Dwelling (4) }ry .a ,l ' .-Fr 4 f'
Residential improvements or Annually , y` i" -'��'�"""
Assessed Mobile/Manufactured Horne Garage (5) :53r -1 ,r trO �'.a `5"'
'S'
n w `W2
Other improvements (6) fr,
Total improvements(line 4 through line 6) (7)
Tctal value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete. I
Verifying action-Signature of Auditor ` \b 14I Ii Date signed
wwzawr _ xr::.-. ''-5 r, :. ZSTAN ARD'DED C 'ALLOWAHCEi;,.: izu?�,3}3��t>r�.?'' +y ./W, c ',,. 0, . --:7
__ 20 Pay 20
lip
1, Lesser of 112 Homestead
^hJ(�/V vauation or$35.000 5
I\ant L. ) 1 -A--Q-0--1-Yrje Signature-of Auditor Date si d
01 -OD