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Mobile Home_Pierce C., CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
CREDIT/STANDARD DEDUCTION HC10
\•,4*,::: f State Form 5473(R614-03) ■
Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
.*nt.a ��-_ �.ZPICERTIFICAIONSTATEMENT✓e^s+?�e;F9.1'g,, .tcx� '.ia-?="%irtiPk€a.
I(We) ���WIN' 1 A . I mall op tI 1sr d-,arch,20
I(We)occupied as our principal place of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned ❑ Are buying under contract OCT 1 8 2003
Have a beneficial interest in the entity that is liable for the properly taxes on the property and that pas the property or s buyinunder a contract.
Ancii� x---:e..r: S'r' .,- '1'1'7: » aY% p , v Lft- UtS,• +re-
irs h��"K;Ygsa�� ,�. -. ?~"'4���'.mCONTRACT'.RECORDED'�a. rsrea•��1::-�'�,c��rsFm��r�����$'.'.:�i.LS'
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
■
- W. `t; '''re :; -. n a'"`" :s P.ROP,ERTY:D ESC RIP,T10N Ae{4`+, ,sr1r.-,s_' ` �� ' ,w,d 5't a.CP:
\a ... I Township Taring district(city,town,to
•
�{ eagoa�7 dpi `
Paber
S t/ L S7 /iptio Is the P operty in question:
—O co —co !/7 {// I`(J�Real property ❑ Mobile Homo(LC.6-1.f-7)
If any portion of the residential structure or the land not exceeding one(�mrLiiatety� at a re is used to produce income.describe the use and portion
of the property utilized to produce income.
g y, ' a '? ROP.ERTY;Oithitt itteaIMUINT-IN OTHER"COUNTIES,`Er .s .fi`,gblers 'fit' i:} ` ' "' �- ' .L"u'it
County Township County Township
I hereby certify the above statements are true,correct and complete.
i lure pf claimant D �` Q
�_4
Address(number and sVeet,city,slate,ZIP code)
5050 w i > )aA►r_C�,�� �` c Q (�� . ( 1 c-Q`r ro
'z - �' y�-� -j�TRUE TAX a- � ASSESSEDVALUE. HOMESTEAD�'`� NON�tEStDENTIAL�
...- ,� A. ES50£l Ov--tttz�c, t, itavALUEY' k'A SAT 100%°OFiTTVi VALUE --S VALUEg_ q ":
Land not exceeding 1 (one)acre immediately at i`„ F; ? Y
surrounding residential improvements. (1) w �, "r
Other land (2) ?_: t.•',0
Tonal land(line 1 plus line 2) (3)
t> Alan}Mohr"
Dwelling (4) ti i �+ -V
Residential improvements or Annually .c+h'x�..x `. t 'Y _
Assessed Mobile/ManitlarArred Home Garage (5) H,. q` .t` `� r
3 e "=Other improvements (6) 3g:4�
Total improvements(line 4 through line 6) (7)
Trial value (line 3 pits line 7) (g)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
W 1 srw52 e'`'rn. elF2,i'2 Orep STANDARD'.DEDUCTIONALLOWANCE..tt-Salna c'_-`]llAr ,v:.. 7tra:.2'.TS==-
\ 20 Pay 20 J
�O� Lesser of 1/2 Homestead \� ``y Vv `nfi
vauetion or ' .000 A \ \ \\ , "
Signature of ,( \ I� /1 Date s�o TDIS'
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