Mobile Home_McIntyre•
• ,1:" CLAIM FOR HOMESTEAD PROPERTY TAX FORM Y
'_ CREDITISTANDARD DEDUCTION HCIO
1�,
'4:;,, State 5473(R5/10-01) _-
Prescribed by the Department of Local Government Finance
INSTRUCTION See reverse side for filing instructions. J J 4
-_': --,:"-.rfi3i�,x 'y.. 44-6sK-< v"�`c,,t7zrr ICATIO STA MENT 4 r' .,.'•-'-,- N�1�i ..: 1Ai l=74;„4. _:r�-� X
I(We) 11� A I AA__ r I. �, 1 t. certify,that on the 1st�da?BYMarch,20
I(We)occupied as ou(principal place of residence the following descried real property f.li which a Homestead Property Ta,Credit'is hereby claimed:
❑ I(We)owned ❑ Are buying under contract A„) (-'`-`- )._ .
C1 Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property oris buying uridbpa contract. -
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.isF.-` .,,---?'' " 'eac�i aa: C x ..:az': s za`?CONTRACT RE CORDED ,;i•+' ,sr gs, . `' �•.'�' ,,ra;:..„s'. x&
if buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
Mel ">;r g. RYA +ti.
® kti��R'e .`''�_.�"`•'. �`P.ROPERT.Y:OESCRIP.TION'rr,,.s'�s -s�.�.-„�,”. was„-';��-._A'ri"r :�' .
County/.r Township Taking district(city,town,tow ,. p) //�
\ am i t, , 1 tonal Y re
P 1 � /� Legal descdp0/qn / Is - pro .rty in q��n:
— /� - W / 9C/"' .. J A if , Aril -cal property .Moblle Home(LC.61.1-7)
If any portion of the residen : structure or the land not exceeding one(1)acre that immediately su • nds that j,-; e is used to produce income.describe the use and portion
of the property utilized to produce income.
W `.'°A-s"�' > - r . - nP-ROP,ERTY;OWNED$Y;CLAIMANtIN OTNER'COUNTIESl`.u,gat '„' '�At rt 4
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimanj OA
Address(number and street,city,state,ZIP code) n � ''iG c i_O
(4 0 i f R4/ sox i.0 A 4 2--..x-c-r v a-✓ aft.- v 76(.
p - ,./-1 1:4L `i.--� T iiitaii ASSESSED VALUE t HOMESTEN- rl iNON'-RES@E�ITL4L
` ASSESSORIUSE ONLY .g r VALUE`11 a'' -ATi100%OFITVI " :VALUED' - w "^r'"-'''
:2les�aSt: �. _ ` � };max �b.u� ..,v - :-,- .._..ri �-C` k%'r�2�4j VALUE .`'ki- .c -
Land not exceeding 1 (one)acre immediately • - F'^ '
'-f
surrounding residential improvements. (1) - z
Other land "` -t,'t-4(2)
Total land(line I plus line 2) (3)
Dwelling (4)
^ '
'°h` •L y "Residential improvements ` .a-73- t 7 z Garage (5) .
Other improvements (6) &4`�''- .. '
Total improvements(line 4 through line 6) (7)
Trial value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor 11)) \ \ 1 �1 11 Date signed
-.. .. "?'a-,Oni'r�:'�x#�;$s.sr� DARD'.DED CTION;ALLDWANCE,�x,,.c3>,heT!^x,." ''.�� s.;*1 }rr„) sc,-�'�.grffi,�+-
• 20 Pay 20
`,\ Lesser of 1(2 Homestead $
�. Valuation or$6,000
Sire of At Date ygn I 6_1