Mobile Home_McCoy (2) CLAIM FOR HOMESTEAD PROPERTY TAX FORM
YEAR
CREDIT/STANDARD DEDUCTION HC10
`♦ State Fwm 5473(R6l 403)
Prescribed the Department Local Government Finance
INSTRUCT-10)1a See rev er se side for thing instructions FILED
0, f.; r t.__. `'.- t :s. .- ..,,:,- ."_�',,, .._ CERTIFICATION STATEMENT ._: _ ..• .. ,
` Eli Alt, 2 2 2005
,
I(We) . ♦_4 a _ .• t/ certify that on the 1st day of March, 20_
I(We)occupied as our pri cipal place i sidence he following jscribed real property for which a Homestelferty Tai, r dit is hereby claimed:
❑ I(We)owned ❑ Are buyin• nder contract ����//p.C./� ,�
•Have a beneficial interest in the entity that is liable for the property taxes on the property and that owed 9brTiniP Tr1 U71 �.a contract.
a
w . >;‘;r sit "`szi.. i .r.2-d?C' - CONTRACTRECORDED- - . . r a
If buying on contract.Fee Simple owner's name
Recorders office where contract is recorded Record number Page
)1.W.1,79 1:'. :e: ,'.t Cy fry-- PROPERTY DESCRIPTION. •z;
Coon Oa \t;I I Township Taring district(city,rol�i, sl��( _1
P r r q/L�,/��(�J /, i
L�� „U Legal description Is the property in question:
r
—CO 4.5 a'IJI,J ❑ Real property yJ,Mobilo 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 use and portion
of the property utilized to produce income.
n-7—' air.kj '`• ÷1"1-7-C if-' c"-^PROPERTY OWNED BY CLAIMANT IN OTHER-COUNTIES aX7K1. 3^. -" i-''r
County Township County Township
o
I hereby certify the above statements are true,correct and complete. Signatur aimant
� 2//j
/
mer and steet,rl state,ZIP code)
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Li 2 o
r -nYi tar ASSESSOR-0SE ONLY...,- TRUE TAX ASSESSED VALUE i HOMESTEAD NON-RESIDENTIAL.
Y cr.}S - VALUE AT 100%OF.TTV •= -VALUE' - VALUE
Land not exceeding 1 (one)acre immediately - � - -•surrounding residential improvements. (1) . , •
•
Other land (2) - -••
Tctal land(line 1 plus line 2) (3)
Dwelling (4) _
t
Residential improvements or Annually _
Assessed Mobile/Manufactured Home Garage (5) l t -
Other improvements (6) l
Total improvements(line 4 through line 6) (7)
Tctal value (line 3 pits line 7) I (8)
I hereby certify the above is true,correct,and Signature of Assessor Data signed
complete.
Verifying action-Signature of Auditor \\,\ Ill / Date signed
\a \� �`l i IX\ l I CUU
-„.; orc' = ._. - .ST DEDUCTION ALLOWANCE".
�• ~'
20 Pay 20
,-II \ Lesser of 112 Homestead
n Vauabon or 535.000 (\
ig to ditty - fr .� - '�''��4�y/I� Date sigrldi � )