Mobile Home_Shafer 4.1CLAIM FOR HOMESTEAD PROPERTY TAX FFOR , YEA CREDIT/STANDARD DEDUCTION I , bc�o 6 AR R
State Forrn 5473(R6/4-03) -
Prescribed by the Department of Local Government Finance OCT 2 3 2003
INSTRUCTIONS:See reverse side for filing instructions.
.`TYrx a"„a 4- I' tree-.._ '."r'rr.' ---,Fz,h, CERTIFICAllON STATEMENTi>t'r\. �. 6,�'�'i.' c la,.(144- «b:: n`s�.f'l ,. �.. .y11
/` GIBSON eoUrITY AUDITOR I
I(We) / _ certify that on the 1st day of March,20
I(We)occup' as our principal place o residen the following described real property for which a Homestead Property Tax Credit is hereby claimed:
❑ I(We)owned ❑ Are buying under contract
al 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.
Mr
AL y ajr'°' ",a_"`' airgr,rw,".CONTRACTREGORDED nt a_,•ta",3,,"43*"xr``n` .'.ns'""'g" .`"``a+ Iii "t a
If buying on contract,Fee Simple owners name
Recorders office where contract is recorded Record number Page
�+ ', .'teraa=1"giii-rag w":ja+ --; PROP,EOita/ESCRIP.TIONf+,-.' `vi' Z v',Ei6 fr >' ",°�"4'�.ig-.._.t
County Tamship Taring district(city,town,township)
.
P mbar criptian ��� 'p Is the property in question:
�j�(/(/ Y/i/-f/i A��� v ❑ Real property bile Homo(LC.6-1.7-7)
1 any portion of the residential structure or the land not exceeding on (1)acre that immediately surrounds that structure is used to prod income.describe the use and portion
of the property utilized to produce income.
' =aS.W. :Cate2 c . . P,ROP.ERTY,OWNEDI BY CLAIMANT;IN:OTHER'COUNTIES'[`!'.n$"',. a;-t {*3 ._�-' ,It:'t:4!'4 W
County Township County Township
I hereby certify the above statements are true,correct and complete. Ski°nature of c mat p
,\ .�L7 //J. "Ai ,
Address(number and street,cr- state,ZIP code)
®Y Jo t& ro4e ,Got Zr V . eifiJe1r r Lr' S'%lo Vt /O.5 G
IrfiC �n;� - r TRUE TAX ASSESSED VALUE HOMESTEAD c- NON-RESIDENTUIL >�
AasSESSOR_USE ONLY-a,,a,- z to VALUE` "eATx100%'OFTN VALUEC °' *`VALUE
i- '% aYfi,RaLE :..:. r-s3 �..- ...1r ......�..>..._�.ram., -,S�t -,.v� _ _ri.e 'Y:,.. f.-inF
Land not exceeding 1 (one)acre immediately .3,A ,,,y %" "7„k?
surrounding residential improvements. (1) ir'e a�.t n_
aan"-
a> .;'.`-
Other land (2) -
Total land(line I plus line 2) (3)
qi.- Pyv{A.i rtft
Dwelling (4) .^ � '�.a 'one
fr Residential Improvements or Annually - i � ,_t
Assessed Mobde/Manufactured Home Garage 5 t„z�- � :
( ) ,'w,,t. .ram'' ` ,.... T
Other improvements (6) ..t< "
Total improvements(line 4 through line 6) (7)
Total value (line 3 phis line 7) (6)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
complete.
Verifying action-Signature of Auditor Date signed
Ok\
®', +-�'�''�"a�'e:t ,�.:, - ,-��_-�t.'. ',e..-bmSTANDARO:DEDUCTION ALLOWANCE'S alrxtc :r. ';�a�^"` i;MWerj,W'.gr-;c
J 20 Pay 20_
� Lesser of 1/2 Homestead
a, Valuation or$35.000 $
Signature of Auditor Date signed