Mobile Home_Norrick ''W FORM YEAR
4 CLAIM FOR HOMESTEAD PROPERTY TAX r
CREDIT/STANDARD DEDUCTION HCIO I
State Form 5473(R5l 10-01)
... •"' ....
Prescribed by the Department of Local Government Finance
INSTRUCT:NS:See reverse side for filing instructions.
-------
1% ,,, ';CERTIFICATION STATEMENT' >� Y `_
Atli ���i)� FEd on 2tda o
I(We) .cemfy that on the 1st day of March, 20
•
I(We)occupied as our principal p ace of residence the following described real property for which a Ho r stead PropeSy Tax Credit is•hereby claimed:
r1 I(We)owned ❑ Are buying under contract � )t' %_ITOR
°7" g GIBSON COON' : AUDITOR cp
..lave 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.'\
AL
Ti..:aahntt, h.Ralf:1gPis'a i'r,,.�Yttlt( CONTRACTRECORDEDz'. ilkIt t4'_v.i 'ui tt=;;Wt,-11"?i.' '^ti.:i. ; .-7. ., .
If buying on contract,Fee Simple owners name
Recorder's office where contract is recorded Record number Page
'_'£". _' .fi .'�X -r•w.`*??n-= z�rtr '>--- .'ir :P,ROP.ERT`/..DESC' • •�y ' .�._ .�..ssxftt ..�'.°fir.� . ..:' : iz:t \;_•.
Coun•, Tovnship Tarin'�� 'rty, own, •c hip)f�
Parce�ber (4// Legal description Is the property in question: ��r
Oa 0 is 'OD ❑ Real property ys Mobile 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.
/ Q9 f(Anie
7S4,1 yz1a2-Tlansix' •t",s ytPROPERTNOWNED`BY CLAIMANT IN-OTHER`CDUNTIES ' -NaVfl-a;r-11 -` tuft
I County township County Tonnship
hereby certify the above statements are true,correct and complete. Signamr di i(nan
ss(number and street,city,slate,ZIP code)
•
/� � T ✓n/1La �� �cflicR ,.rdiq.,ra 474 4 4
a" .tW3£� `''Ti a ?"'it T W`TRUETAX't'g } ASSESSEDVALUE +HOMESTEADSk it ✓aNON-RESIDENTIAL •
t•i'�`�' ASSE38D NLx � ltt .VALUE ..1, "AT 109%-oFTTVs, r VALUE; i, v.s VALUEc;,, ,'
Land not exceeding 1 (one)acre immediately r }t,51:$ `fi` rt1 <- *£
surrounding residential improvements. (1) , ? ' r , •_
,.....,._ 4.4.. _? �N_,t: _
Other land (2) 0r45f114* _
Total land(line 1 plus line 2) (3)
Dwelling (4) .a�i ' t�''f-14, �i°i-r-,-,
Residential improvements • sue,, t - ,,,
Garage (5) -, 1•s ` _.'. 1, ..-.. ,
x as7� c''E - yr u
Other improvements (6) r 4 ,.4yY4,1 !w`
Trial improvements(line 4 through line 6) (7)
Total 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 \T \b \ `I Date signed
i \\
AO aatzy`+ 'sv'".ra"•3' E a` ge--4,1. DARP:DE000TION�ALI:DWANCE:rS'-;""- 6; ..-vs�`S,'-'t-fr-fr a >.. .e�k Yt...f„tilL
\\ 20_Pay 20_ \
b \�1
Lesser of 1/2 Homestead \� 0 $
Valuati�(o�)n or$6,000
Signal\of Ayd / 1% /'-(' , Date n
y/) ,fie/f �T\/--rl , o�- d 7- d,