Mobile Home_Martin Z CLAIM FOR HOMESTEAD PROPERTY TAX FORM
CREDITISTANDARD DEDUCTION HC10 YEAR
State Form 5473(Rfi/4-03)
Prescribed by the Department of Local Government Finance
F i L Ei) .
INSTRUCTIONS:See reverse side for filing instructions.
at"--d'3 t. 77�7��/I"��°:. -° /�-1-:1-7'''''. "4.(1,. CERTIFICATION STATEMENT _ C�.Q- 1 ,I F_
I(We) /,n /(/1 1 t ALA. RA () y> certify£Fa t11e At 3�ef March, 20
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned El buying under contract rQ
�\ Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns w y
O[lia contract.
ts
V./RS+ t.4c 1 .w. ... :; _ . CONTRACT'RECORDED • ,.• ' • -^:k'-..
If buying on contract,Fee Simple owners name
N.
Recorder's office where contract is recorded Record number Page
{y.'` 'cA:Isr ?-. c:c.r-* - .:5-"n• PROPERTY DESCRIPTION'.ti - . _
County `y Township Taxing district(city,town,township)
P r umber 11.-0.1 — Le I descripU•n Is the property in question:
�} ,�Q(� - P pent' g
. D DO U ,r• ❑ Real property Mobile Homo(LC.61.1-7)
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.
ft ,Q'_:'"' t r 4,tea - PROPERTY OWNED BY CLAIMANT IN OTHER"COUNTIES .. ' s ?1•'? .
County Township County Township
I hereby certify the above statements are true,correct and complete. S i•n. , of aril
!� yak
Address(num r and street,city,state.ZIP code)
40 /yo,f
r')"`'/'N 'ss - - ` TRUE TAX ASSESSED VALUE HOMESTEAD NON-RESIDENTIAL,
.x. l?7ay , ASSESSOR USE ONLY__ .; : - . VALUE AT 100°/:OF.Try - 'VALUE '•=i.VALUE:
Land not exceeding 1 (one)acre immediately - - •
surrounding residential improvements. (1) , , ` •
•
Other land (2) - - - - •
Tdal land(line 1 plus line 2) (3)
Dwelling (4) _.
•Residential improvements or Annually " '' - -
Assessed Mobile/Manufactured Home Garage (5)
Other improvements (6)
Trial improvements(line 4 through line 6) (7)
Tctal value (line 3 plts line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Dale signed
complete.
I
Verifying action-Signature of Auditor \ (b p Date signed
ri 3 _- : :.. -•. '.: - - ": ST DARD DEDUCTION ALLOWANCE. . - -
20 Pay 20 i
1�`\ Lesser of 1/2 Homestead •
v valuation or 535.000
Signature of Auditor - 13 Date�Signe i L •(Da_
C_ `�,`�_ _ r T T T'r_Tr-\- ----'