Mobile Home_Risley ga.J CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
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CREDIT/STANDARD DEDUCTION HC10
' State Form 5473(R5/10-01) T,1y�tt I -� 1
Prescribed by the Department of Local Government Finance 1 1 , 11 f..
l�(SIRUCTIONS:See reverse side for filing instructions. SSSS
s mtz-P '-_ *t^` r cERTIFlCATION,STATEMEtfr; fzs Faa r •. ..:2--key.=...-_ 1' 'x �m
I(We) certify that no the 1st day of March,20'7 0
I(W occupied as our principal place of residence the following described I property for which a H estead Proo rCr�i ptarty`Tat.isd ereby dalmed//I(We)owned 0 Are buying under contract
\D Have 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.
\ .a a ✓i:l* F` tereast,^ r.i :'ni.�.fa re CONTRACTr:RECORDED- -;, ' 3 ° C -^t `'4"'MF` atlra'3`.'�'a
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
`- : a>.__.eh P,ROPERTYZUESCRIPTIO "-:'`'-�,_'?c"2� et---'' +- -* ��+ ' i' �'^
County Township Taxing d � �town,township)A�
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P cel num 0 G �(j g a Legal7 d� Fta�r )� Is the property in property
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_ 3KReal❑ property LlS rlob le Home(LC.&f.1-7)
-Iran of the residential structure or the land not exceeding one(1)acre that immediately surrounds that stnrdure is used to produce income,describe the use and portion
of the property utilized to produce income.
It �.�-� i--�',+i-..t �1''�+it ,isr'q,.r! zisff-MiP,ROPERTY;OWNEDBY;CLAIMANTINiOTHER"COUNTIES�.m?r,...'ai `7t "- 1 �-- - --
County Township County Township
I hereby certify the above statements are true,correct and complete. Sig.at dai
`'�6-dfr /c �%/
ddress(number and street,city,state,ZIP code)
-z `' = -"�' " ': 'S 4% S'TRUALE EW $. ATS1SED.V al li HOME TEAF7-: �'-w ANON-R S�ENTIAL t
b. ASSESSOR USE ONLY 'ge `` ":�?}u "}'
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.s '�'-�`t.' 'x.Rl�' raft'! ? �a�`�G:ss"3i "�i ..�� ~ aS..,.W.—>,ew.a.-��;-,,...,...rat .u'-'vt'�i"5s.... �'.,.
Land not exceeding 1 (one)acre immediately (1) u. n., , am:a r.
surrounding residential improvements.
Other land (2)
Trial land(line I plus line 2) (3) \ 1Dwelling (4) testa:z�; 't „
Residential improvements pli< -Tit-Fr,?
Garage (5)
�. r :ir . sx+. '-
Other improvements (6)
Trial improvements(line 4 through line 6) (7)
1
Tctal value (line 3 pits line 7)
I hereby certify the above is true,correct and It V
natur Assessor Date signedompleta.
V ractionifying act -Signature of Puditar � Date signedw=r r 'a -r s Ic t_. 1teXt , ;STANDARDAEDUCTION ALI OWANCE `e_o; .,' _y a'!€ mz�-"^,`rl1`tir = ` r
ill20 Pay 20
\\ Lesser of 1/2 Homestead
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Valuation or$6,000 . Id}. \, $ \\I oiV‘I 1
Signature of Auditor
\ Date signed