Mobile Home_Selby (2)�r
41An
. .,, CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
1� • CREDIT/STANDARD DEDUCTION HC10
` • -'Y� State Form 5473(R5/10-01) I
wiii Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions.
_-sr' '€ ._i1 'i ^`: t°u,-IT+.:�if'""'/,'- ,c. 1 .24 .;CERTIFICATION STATEMENT�� .) .Y t R 3 :t ..
H .
I(We) ®/I / ' /�,,, ' certify th ou tlj_1 • a rrith- •-•
I(We)occupied as our principal place of residen ,e following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned ❑ Are buying under• .• ract JAN ;J i 2002
II Have a beneficial interest in the entity that is liable for the property taxes on the property and that owns the property or is buyingundeer a contract.
}/(� / // n
t4.4 $$.piiwF kr.3T" ialyiL`z°31..11h;"*'"r:'r,i'-s CONTRACT.!RECORDED."',a7aa,- Y.;Z'!S- {SSOPt;COCt4WART(;R--I;
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
%a`��..c£-`•�'-, Zit: . _v.'�*`:l V r'm..:4'is3"f`u=PROPERTf:.DESCRIP•TION �h".� ''n i. e y°t is .a it' `„ W'." .
County Township T log d' ri (city, .wn,township)
�a _ 7` f
Par- tuber n �//1{�/(��/ legal w Is the • 1•.rty in uesti _may/
''/ki — QD/% / U � � f l�62 r ❑ Real property {p�Mobile Homo VC.5-1.1-7)
If 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.
..c, -a�.:'i� �'iF� "tS4_. •� ..�`ulS}''��i'r;.�fia3.-a-,�- .°*�F�1e.� '.
_e:3�-k,_.��.-i„4,.._x�t?�**1 . ,-,...�.1iPROFERTY.OWNEDBY CI'AIMANT IN.OTHER'000NTIES �,,.
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and street,city,state,ZIP code) -
yAt 1` +f"}S-Wi ri5`r''"'11 t:54 iv" C•, rTRUETAX '� ASSESSED VALUE �yHOMESTEAD''n s NON,RESIDENTIAL %
c}ric. AS ESSOR S,a,ONLY-F_c. . t" :`fir VALUE 3r �' g AT 100%OPiTTV �' e:VALUE ' > r.--VALUE'- :{- ,y
"a'i_ itR+. arc -ik _ r; d t'... .5-- Er' 1.... -3
Land not exceeding 1 (one)acre immediately i, -1 $ �"s�•r ^ es ; y,:I
surrounding residential improvements. (1) v14, ky'.kk '< ...aye '*''
Other land -r`) �•-r 41
kr
Total land(line I plus line 2) (3)
Residential improvements Dwelling (4) �4gir WA A}$3Y _ re
Garage (5) •"ra'y' .tAs h v -.z•F' ' -l-ii•
Y M '-ja,;
Other improvements (6) -tom ar rF,,.
Total improvements(line 4 through line 6) (7)
Total value (line 3 pits line 7) (5)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of wditor /I I n Date signed
\ \\Ibl ,\`A ,
' t ,'E. .11=.}jvl�#c�l„G,�`,?'f%`e sv:v ,•- <.'i .;.
TANDARD,DEDUCTION'ALLOWANCE . .; d "> a' " =>~ F
��0 20Pay 20_
a94 Lesser of 1/2 Homestead S
�1 Valuation or$6,000
Signature of Auditor Date signed