Mobile Home_Sims i.
. CLAIM FOR HOMESTEAD PROPERTY TAX F* _M ,� YEAR
fir) CREDIT/STANDARD DEDUCTION HC10 •
State Form 5473(R8I 7-07)
Prescribed by the Department of Local Government Finance it.
l 2009IT
INS f i w-f funs:See reverse side(or filing instructions.
- , CERTIFICATION STATEMENT . -
/ - � ) • NTY AUDOR
I(VY /e) I /) /y certify that on the 1st day of March, 20
I(We)occupied as r in I plat a of residence the following described real property for which a Homestead Property Tax Credit is hereby claimed:
iI(We)owned 0 Are buying under contract
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.
- CONTRACT RECORDED .
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
- - - PROPERTY DESCRIPTION
County Township Taring dill t.. .(,ciit.y,town,toe hip)
O '/L '
Parcel number/ / 1 Legall description C._-^_� Is( the property in question: ,,,���...,,,///
( o '7 Oti 6 -ooA/a'cc ) ! / A S^-^-aet f f,o f ❑ Real p L Mobile Home(lC 6-1.1-7)
If any portion of the residential structure or the land not exceeding one(1)acre that immediately surrounds that structure is u roduce/Inc- me,describe the use and portion
of the property utilized to produce income.
• PROPERTY OWNED BY CLAIMANT IN OTHER COUNTIES -
County Township County Township
•
I hereby certify the above statements are true,correct and complete. ( •
Signature claimant
��Ta 'tess(number and street city state,and ZIP code) \
J On - PoIe <,-F- LoIt + 21nncv, 1AI, 47/o' Y
• l ASSESSED VALUEI HOMESTEAD , NON-RESIDENTIAL
ASSESSOR USE ONLY ' - r I.
TRUE TAX VALUE AT 100%a OF TTV I VALUE ' - VALUE
Land not exceeding 1 (one)acre immediately - ; fT = i,
(1)
surrounding residential improvements.
Other land (2)
Tctal land(fine 1 plus line 2) (3)
Residential improvements or Annually Dwelling (4) _?-F`rµ,.
Assessed Mobile I Manufactured Home
Garage (5) •
Other improvements (6)
Total improvements(fine 4 through fine 6) (7)
Tctal value (line 3 plus fine 7) (g)
I hereby certify the above is true,coned,and Signature of Assessor Date signed(month.day,year)
complete. /
Verifying action-Signature of Auditor A( /� 4 Date signed(month,day,year)
� �\
n 0\\ \4 , C �"6 I`0 \ 1 ,
`STANDARD DEDUCTION ALLOWANCE - - - -
z0 pay 20_ 45,000 for 2007 pay 2008 42,000 for 2010 pay 2011 I.
Lesser of 1/244,000 for 2008 pay 2009 41,000 for 2011 pay 2012
Homestead Valuation $
or 43,000 for 2009 pay 2010 40,000 payable after 2012
Signature of Auditor Date signed(month,day,year)