Mobile Home_Simmons •-_' , ! € € RWTM
. -2__
Pmasabed by the Department of Local Government Ferman
u..rl HUC71CNS:See reverse side for filing instruction. MAR 1 9 2008
•` - . . ' ,. . - e CB2T1F1CATION STA7ElBENT:! . " - . 't. m• .-
I
I((We)oralur' as o principal place of residence the following described real property for which a Homes � d71X�(i nit y claimed:
I(We)ownedElAre buying under contract
Have a benefidal interest in the entity that is liable for the property taxes on the property and that owns the property or is buying under a centract
is ', ,.'.,. . - .; ; . ' ;: •' .•CONTRACT:RECORDEDvna- .. :"i r,. .. Sa , 7:trt. m r Ka,.i'
If buying on contract Fee Simple owner mane
rre. .: .... -
Ftemdm's office where Mad is recorded Record number Pago
" o, •. ,.. .. .. , . 'PROPERTY DESCRIPTI - - . .. ., . -t:. - r '.� o ... , .:1. c�..ft
County //^n/ /� ' Township Taxing ' ay,town,t " )
7A6
Legal description Ls the property in question:
Cain;
R®i property Mobile Horne(LC.641-7)
x any portion of the residential strode or the land not maeeding one(1)acre that immediately surrounds that sbuA+e is used to none,describe the use and portico
at the property utilized to produce income.
`;, ` . •- 1. :PROPERTYOWNED BY CLACdANY M bTHER COUNTIES'. . '' ,i. <_�:" i.e ,',$.;.. frF'.� t
County Townshipen County Township
I hereby certify the above statements am true,correct c«rplete. �re of
(daim�ae .NU./IXAQ.w(�. e C. �A_.re.rx cwwd J
tress(number and street city state,ZIP code)
I P. O Rok P-4 Pr: ncPlo�,,Tr `{1rov
' {?:: "'TRUE TAX ASSESSED VALUE :H0 ¢STE 9ADi '^*''NONm4tEN SENTIArL ,"
-,...,1",: .r ASSESSOR USE ONLY , e, my tip , :mAT100%OF T 'iv i. •VALUE,.;:t' '"• ..4td' V�tt Er.?t. lt!., .t1�'.
Lard not exceedng 1 (one)acre Onnediately IC .p'.gyr _4 n iN CY t_' +a 3
surrounding residential impu...rtcnfs. (1) r J; r> u k 'Y, nti I
Other lard N
Trial land(line 1 plus fine 2) (3)
Residential'improvements oAnnualty Owelb g (4) rr:"�".u'rt: r`t`xa w ;i`w , 1
Pew•�vd Mobile 1 Mantdattlsed Home if •' r . ) r
Garage (5) ikiii8 reA +� T � ry. .....isnw ... 3:, -1.... A + . a„
t! ..1•� s:.i.�.
imp
rovements provements (6) .. .. .'.'..
Total'vnprovements(lime 4 through Byre 6) (7)
Thal value (tune 3 ids line 7) (S)
71/4
I hereby certify the above is true,correct,and • Assessor Date signed
canplete.
Veilying action-Signature of Aucktor Date signed
53y\. \1/41\1
r • - . • .ARD DEDUCTION ALLOWANCE r.;.4 i) .i : 4 -"I' eCzte-1:tit r . ,y
J 20_Pay 20 Q \ 11h
Lesser of 1/2 Homestead \ . \S \' 1 `
Valuation or f35,000 `\
Signature of Auditor Date signed