Mobile Home_Phillips ,' f
CLAIM FOR HOMESTEAD PROPERTY TAX \ FORM YEAR
7 CREDIT/STANDARD DEDUCTION HCID
` State Form 5473(R6 1 4-03)
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. _� __�
IT h It i
. s'°. i-"'" -,d"",> ° e E.,tt`» .z i,'PER FICAj1ON STATEMENT Atr_it„t� ?ii a r -.two yr r 7a'
I we .I.,L y I .- ;I. certifyi jai onthe "Oft of March,20
I(We)occupied as our principal place f res./.nce the following described eal property for which a Homestead Property Tae trredd is hereby claimed:
. ❑ I(We)owned ❑ Are buying under contract u / 0 n
(� Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns'the property-/or_is:buyittg-under-/a'contract.
\ " GI=.SON COUNTY AUDITC3 I
c: r€rsx.} .z �fi`- `. P' 'k C dTRACTRECORDEDt ".s z: 'at 4 .. t">'+'r';
If buying on contract,Fee Simple owners name I
,Ii Mat 2 ��i. "Fyn"j t S.... 11 '.
Recorder's office where contract is recorded ' •ecord number Pag=
s 7.0:4 ' `wig acv-r�r+n.."?k?k x. .a P,ROP.ERT,`ic.DECRIPTIONS',- ` ct iA '.. .7-aa' %r. .a..4 E'ftx `i,/
County Township lacing district(city-LI
P rcel nu ber ^� /''� Legal description Is the properrtyr/in question:
— 0 4 6o1. —tiff ❑ Real property LIB bile H (LC.6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds tttt structucta�is used to produce come,describe the u and portion
of the property utilized to produce income.
95 Deli M , /1 // �'1
-(too-off fr• 060_,D . (Y`-.3-Li
-:_Er �- _---_ .__- ,rsu� ��^tiPROP,ERTY,OWNED;BY'CI''AIMANT,INIOTHER COUNTIEsITZe:`�`r.�.3`i��?�G�'.,�'�' r*WIA
County Township County ITownship —I hereby certify the above statements are true,correct and complete. Sig re of claimant }I.
� 1
Address(number and street,city,state,ZIP code)• ' / /G
((9-r-rw ddr---' d Y7-G - moo -�a7 low d ,t/
f e < ASSESSOR USES ON Y-T- iTRUETAX ASSESSEDVALUE '' HOMESTEAD NON'-RESIDENTIAL! ,' h
?ixf -s"v r. . . ._ Serf`w, g raj VALUE..sT7 _ATa100%e'DFsigYa.revALUE 4c VALUE.a, ;flA '-4
Land not exceeding 1 (one)acre immediately ?i�r tgtm
surrounding residential improvements. (1) Y a # ?fir
Other land tc - w,°'r
(2)
r-°
Total land(line 1 plus line 2) (3) T
Dwelling (4) 1 St i't w n ,.,,.wr° �c`Y+tra
Residential Improvements or Annually ;^°� r� . a..6.
Assessed Mobile/Manufactured Home Garage (5) 0.0 arch g.
Other improvements (6) err "Era''�.�� = t
Total improvements(line 4 through line 6) (7) u
Total value (line 3 plus line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Pudibr\�\ 1\� 1� (1/ Date signed
n
S .0 ?A n. :gS`€!?8t,' t, sera" S TANDARD,DEDUCTION'ALLOWANCE..,tiapa3�3`iiL` f.Sy; qy�"``-+zt' t �,r-` Y,Sit`'. a••,,^q
20 Pay 20_
Lesser of 1/2 Homestead '
V auation W
or .000 $
Signature of Date ed