Mobile Home_Meyers k' CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
r CREDITISTANDARD DEDUCTION HCIO ilik
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State Form 5473(Ra 14.03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instnictions v---1 f' TIT 11
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�"�-x: ,: .,..> / ,.� .,,,CERTIFICATION STATEMENT'S _, Ei �tF. -xt,� .Y-�.
I(We) /\ .�i� / l `�J�,'�,,Qft f�� certify th�t`on the 1st de/o�f{March,20_
I(We)occupied as our principal place of residence the folio v t described real property for which a Homestead Property Tax Credit isThereby claimed:
❑ I(We)owned ❑ Are buying under contract U I / 9i o /I1
S Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns thuee p"rpperty`,/or is buying unde'a contract.
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�?3�gaFSa' ,"xr '.,�:.=-YaWge- "CONTRACT;:RECORDEDI,',"r.TZa-E=•-gr-Z .;�'r�4io`•, ..+-�arl:s ea;ar:-v:: • 'iy
If buying on contract.Fee Simple owners name � _,
Recorders office where contract is recorded ,; Record number Page \\
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5--��4.1 ;.W.tr's-^A i ` =_"Si T-:P SW,NPROP,ERTY.DESCRMTIONIIre tti trc°rs�.t-v Ct_e +,I"i'°A1•.
County Township Taring district(dry,town,township)
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Par I number dK Legal description Is the property
C �.y p y l P� P pent in question:
�r/w O 9'' `& 9 / PLC. /_ _ ❑,Real propeM MobIle Homo(LC.61.1-7)
H any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is used to produce into ,describe the use and portion
of the property utilized to produce income.
a),....eirAsecti C
ri ,<...r�y�� �.�F "��''.r:.._ V.ROP.ERTY,OWNEDiBYCIAIMANT:IN!OTHER"COUNTIESrs <:P--'fi'sr�,-r isy,' .,• l.•r_.,: -;n
County Township County Township
I hereby certify the above statements are true,correct and complete. Signet e onc `
Address(number and street,city,state,ZIP code) /
0
T---.r.--,L..-.. 4; .•r°�- c ' e_t Y "45 TAL'UE 2`A`AT ONF..TSY t HOV TEAR .NOVA tIIENtT1A11:4tn �
z: RrUSE r '}73' 4#- A__.E i ce '-.,.£...,..., _ ,I: � utlY-A1 .�',A-N__
Land not exceeding 1 (one)acre immediately �` p ' -;: "b z -' a,ts. la-; r-
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surrounding residential improvements. (1) -.,e " + -'^ "Xi ''l
ieti 5.;,;(t«:,.. . ;:- i
a Other land (2) 44-44E-z.
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Taal land(line 1 plus line 2) (3)
Dwelling (4) klatinttaa :rVtal
Residential Improvements or Annually
Assessed Mobile/Menufaclured Home Garage (5) .'itr ,' + s;`':t1
ar 4 ,v s,:i
=fe"•) -%
Other improvements (6) -=r`.:-; :rtA:?•
Total improvements(line 4 through line 6) (7)
Taal value (line 3 pits line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete. {{{ \ I I T
Verifying action-Signature of Auditor I� , \/ \� '(1 0 I I Date signed
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t_ -ZWAr. }" ttu"s4ij .',-a:71: /WDARD EDUCTION;ALLOWANCE..:ar ?,,..":a.¢...iana-:,• ;n>.ardigti.' 0V.f-.'.._.
20_Pay 20_
\ Lesser of 112 Homestead $Ov O Vatuatron or S35.000
Signature of Auditor I Date signed