Mobile Home_RitchieIW
no.
CLAIM FOR HOMESTEAD PROPERTY TAX FORM
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'•-r• CREDIT/STANDARD DEDUCTION I HC1O Si I
' `:MtH,> State Form 5473(R5110-01)
WO Prescribed by the Department of Local Government Finance pA
INSTRUCTIONS:See reverse side for filing instructions. FILE (,!
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„. k r 1 -F 1.- //:-. - ' CERTIFICATION STATEMENT M - -
I(We) lie,M Z .� ) certify tJiA It2 Tt 2032 March.20
I(We)occupied as our principal place of residence the following described real property for which a Homes d Property Tax C dit is hereby/1 claimed:
VI(We)owned ❑ Are buying under contract I/ . I 1_
slave a beneficial interest in the entity that is liable for the property taxes on the property and that of tkaieeapfarttialsifiuyipgjo4efa contract.
cg a, CONTRACT'RECORDED ai:;' .- - ' ^i•: .
c-.�so-'M'.'.�c'�Ssr�w '..�,zt`ur y-£�r i.+x � .r�� 5- ..
If buying on contract.Fee Simple owner's name
Recorder's office where contract is recorded JI Record number I Page
,��^4:tip'. "r* , . . . :hy-.i u . .: _. _.�� '- .PROPERTY DESCRI ION. -
County V/'v, Township I Tasin district(city,fo n Township) ^ ' C��/�//�
�/ / Lege a cription J Is the property in slion: /``r [�// Y •
P.�'t �r r O �� / / a. ❑ I property LA�1obile Homo(I.C.6-1.1-7)
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f 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.
T.- r7t ,, :' w T'- ;11.'''' .e PROPERTY.OWNED.BY CLAIMANT--IN;OTHER"000NTIES+� `.: ICi. s Tc .�'f.f2Sg` i .. - -.
County
. „ .
Con Township County ITovnship
Sign aire gLflaimant
I hereby certify the above statements are true,correct and complete. o
;- , n /f
y
' re s(number and street city,state ZIP code) �/t-two Lf/
iii
1zE / R n x- i I"U/9-79 /ii4Zz ci-au 7_74-r✓ L/ 7 (o vn
.i ihr ic ia:-. <,_: -1 Artram TRUE:TAX :� ASSESSEDVALUE -HOMESED' f P NON ESIDENTIAL` '
. M ASESSOSE ONY r' 7.r --t: a 'VALUE., ,t: 'AT100%OF TN.. . .,. VALUES. ' r VALUE .,i'n3e `;.
ii,
Land not exceeding 1 (one)acre immediately
(1) r .-
surrounding residential improvements.
Other land (2) ,, N„
Tctal land(line 1 plus line 2) (3)
Dwelling (4) f'F>',,..:ltitF?xe..,._.1.44aG`
Residential improvements I {T."'4-4qiitg r 4 ;; r•. ::-
Garage (5) y..y-„r?'.:,y.C..t ,.,•.t
Other improvements (6)
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 plus line 7) (8)
I hereby certify the above is true,correct, Signature of Assessor Dale signed and
complete.
Verifying action-Signature of Auditor Date signed
®a,c Theti � zi ^t.r ;:trig ti=:STANDARD.DEDUCTION'ALLOWANCE `%` 'ca5,: --:s` J `L' :t;T:5 r =_iez-•=---
20 Pay 20_
Lesser of 1t2 Homestead \
O�� Valuation or$6,000 \\ S �
1
Date signed
Signature of Auditor \\