Mobile Home_Peakr
CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
1.41*1 CREDIT/STANDARD DEDUCTION HC10
\...b.:..,,o State Form 5473(R5/10-01)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
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I(We) ‘l Ck .1.1%1 alfria V. 0 AP -it;ide 4 i 63
certify thaka__ t day of March, 2O,
,
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I(We occupied as our principal pl of residence the following described real property for which a Homestead Property Tax Credit is hereby/claimed:
I(We)owned 0 Are buying under contract
cikHave a beneficial interest in the entity that is liable for the property taxes on the property and that owns the i tin' bride; a contract.
se
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If buying on contract,Fee Simple owners name
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Recorders office where contract is recorded Record number Page \
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A-MITST-FC.RAKT.:Cirkterc:jr..-WIre=ra;rfit:e9o1111:S=21,2:1102t1t!-EAT,SibtSdRiltritiPenCES4-litra-Z-V(7,(nZl.,terik,1 ::)2:11"5..1:4"-;3-W-;fk&-,ZITi;i':.fi r '
County To.vnship Taxing district(city,town,township) —
Parcel number Lka.,...\3 Legal descripti Is the property in question:
kOSSty - 0 5 - at) -lts C0.i.nnt%se...,1-- a Real property 0 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.
11;41:S.10:44-1255C7,:Wrilliairtic,:M PROPERTY:OWNED BY CalMANTIWOTHER"COUNTIESt:57-7 (7)W-aWZ.-t .1..,4;.y:1-.17,: ‘.
County Township County Township
re of claimant
I hereby certify the above statements are true,correct and complete.
A geAL
Address(number and street,city,state,ZIP code) Ri? Brac '. c,_,r3-et, 1/q e.es 41e-
-111
Tu-%.-tvaityvztrszeiritsitzsisktz*K:: ..;Atfir-t-u-ty-A:Irtza5 ia-sb-si-ii:,yzuse,„.:1:4161AiliUii.,,,17,.!VifSiTterNiiirge-ritiZlic:7
..W.„41.71:51:4ASSESSOREUSE.ONLYgi,:gwsa-7?-el
VALUELe'Sitrik:744TA101:17A0E3TIV.... ;" '4%.4'..VALUE.57..1.7. ..ances.r-gie..1` ,.,"VAli.,..4.--EL.,wal z'cilittsIPPI.
Land not exceeding 1 (one)acre immediately :}2i4V-24-tineanitif;:-
surrounding residential improvements. (1) C,CV-"C c----4,3,3%.,:ur-.2.‘fitstice..,-•
'Ot'•.-i:-3-.,-.--hi.-:4-?:.f'-i.a_i_:,.;
Other land (2)
Total land(line 1 plus line 2) (3)
Residential improvements
Dwelling (4)
'fl-l..-4,4;1_1/4.-8. ".triffffillgrirall:a!,,,sL
Garage (5) 41ST-Vreit' gra?.
no).5;175acifat;;.:`,41,-X
..,iit•t--#..r.;;;--...,,,,,
Other improvements (6)
•;:2*vtilti...7ret-t
Total improvements(line 4 through line 6) (7)
Total value (line 3p/us line 7) (8)
,
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
rake.MatS-na-Oatigalttritl,a13.42:07,',.c.STANDARD DE D CTIO N ALLOVJA14C E.ffira'irrlSatt.le * -5-l..•
MP 20 Pay 20 ki
0 Lesser of 1/2 Homestead \'à\ 1 \CD \
Valuation or$6,000 $ \k\\b kik
.
Signature of Auditor Dale signed
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