Mobile Home_Pearson no.
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• --.-4• % CLAIM FOR HOMESTEAD PROPERTY TAX • FORM YEAR
--NA l'i;. ME
: CREDIT/STANDARD DEDUCTION HC10
••,.-• :....;•• State Form 5473(R5/10-01) —
••■•
Prescribed by the Department of Local Government Finance v Ili
. ,
. INSTRUCTIONS:See reverse side for filing instructions. - 1
Wirshlittit/4.4-4Tc.ar$:$40,efeitV.V7Z4V715.4-ft:t9-2:7:t. CERTIFICATION STATEMENTfifi;.-: .TT.72137.ii:::::', '-; :4-W.ze.,51•092y ;(?
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l(We) 14 4.0.A.p.. att.() Q.,,,,..... ?sae, .rtify that on the day of ar 20
I(We)occupied as our principal place of residence the folloing described real property for which a Ho --. ead Pr•.e , daimed:
t
III I(We)owned 111 Are buying under contract
Suave a beneficial interest in the entity that is liable for the property taxes on the property and that owinsGthieBSp2oNpeCrtcoUrikilsibiuyiP'nUgpluTn°dRer a contract.
ItIaP,S4Wle4YiteitilWigg,e.M.7.A41:34g-24,9g,,I,r;COAFf RACTIRECORDEDint-31fari-kWAA541=5-.0::7:Stfini-7,-t:':':•=t; .."‘,- '
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
!-.L,---flicTectlairtsf:le'ltr-,41.:V.fra,APVitli;141.4 Fi Rb 0 Enti.litSdRiktio N f34-;5P47::::?-1,-cat CIACC7ft-ALTS&,-,a:M"-alfifi-fhtt i.,T.ilf-‘
County Township Taxing district(city,town,township)
rsel mbe...r( Wcs.00 Led ciciaiitiodpatAAA lathe property in question:
Li Real property EiLlAdelome(1.C.6-1.1-7)
If any portion of the residential structure or the nc 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.
Itra-WeiWateitniati:MrStatirA-PROPERncoWNELL BY CeAlMANT IfirOTHER.COUNTIE$1W.4tVgintralaa.W9:011-E',tif:
County Township County Township
Sign lure laimant', fit
I hereby certify the above statements are true,correct and complete.
.404110n
Address(number and street,city state,ZIP code)
.,T4-11aralit-=t5rati---eTiir.Wistclill: 4A grilaFirXtV71 WiSkISEDALVE HabilirA51 111.:14;itaiiii60:0 )
rCAAVATAISIYgAleAMMIII4Ska
VA WAIALUE14fite-,4:.77a-vgrA, 79F.,,;:qyti • ,,,,,cifi;YA.1.41gr* os_.tectiatayAwE tgssatft:
Land not exceeding 1 (one)acre immediately riOtintSitk.ttFrP):kaTti±:;:
surrounding residential improvements. (1) Isj;t1 „,•.exriece,.,44ntst.4••- -7-----•
ct:IiLifirS;41),Lx .:^f..xtgc•eiTi"
i itr•+41.9..,1-V74
Other land (2) d•rle•rtaTiff-4,..,2445.,..j,t1
ct;i:•PR.V::::: ::•&)
Total land(line 1 plus line 2) (3)
.. pfilfctifigit;it'S—C74141111•411
Dwelling (4) u-ljel .:.411t1:::44.; .eASA•
Residential improvements
k-Feja
Garage (5) Igi,FASA-1.: -$4ti/T2-!:
—
... .1.,._:::•-ficrar-Wi:'71:4);). \
Other improvements (6) •V.a..i.."•72.,•••,-.. ..„,tx
Tctal improvements(line 4 through line 6) (7)
Total value (line 3 plus line 7) (5)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action.Signature of Auditor Date signed
arnwiir..-4-yrds...- -aigiongsTANDARti..E.
\ 20 Pay 20
r 10\ Lesser of 1/2 Homestead \11.21b. \PD \ $ A\
0' Valuation or$6,000 \ k
Signature of Auditor t. ..Q..4,1 (.A...) Date=()so D
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