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Mobile Home_Staleyla YEAR Ktrur.\ CLAIM FOR HOMESTEAD PROPERTY TAXife FORM - �' '^ CREDIT/STANDARD DEDUCTION HC10 �` State Form 5473(R6/4-03) Prescribed by the Department of Local Government Finance __INSTRUCTIONS:See reverse side for tiling instructions. ist 0 iz} gi•. a' -.r ?'rWi 'lie h.< s# .cERTIFICATI.ON STATEMENT: ..;a- � :_( !vst . - 1;;, • Ti I(We) r le certify th t((p�thgq 1spN—.-I,o6 March,20_ I(We)occupied?o i •-ncipal place of r-4-rice the following described real property for which a Homestead PrdISA vac or-•I is hereby daimed: ❑ I(We)owned 0 Are buying under contract - (a'Have a beneficial interest in the entity that is liable for the properly taxes on the property and that owns t.- • oper�yr s yi yl n.- a contract. 1 r RSCN COUNTY AUUDIT°. :tt mlaM W5Mx . "kT=d yvlaZon iCONTRACT;RECORDED M.4;.-: $1.s !,c.:..44:' 5 z :Sear):4e ait r-_ i .; If buying on contract,Fee Simple owner's name Recorder's office where contract is recorded I Record number Page T>'2 gag suAM +'s* SWti. t rrmta,v'"vss'��:s.PROPERTY:DESCRIP,TION-inlet.. tt-:. ;x.; ,-x,>c.',`.t'-` ,<a. _'-5+�WiL r-- County Township Taxing district(city,town,township) Pl�{.I�num�ber )eq4sff7 Is Ne poperinquestion:❑ o ❑ Nwbee Homo(LC.6-1.f-7) d any portion of the residential structure or thland not exceedi'ng`one(1)acre that immediately surrounds that structure is used to produce income,describe the use and portion of the property utilized to produce income. '= -Zarc ram;,. _. . W a - -- N - �v�ysagysr .yaix z^; .::=' zcasr .r,, ��•,.,,,-��, �"`-cty,t�vP,ROP,ERTY,OWNEDBY CLAIMANTIN:OTHERCOUNTIES, �...._ t�..rufi.+* ^. unty Township County Township 9 I h r rtify the above s/ ements are true,correct and complete. r••tSignature of claimant z sot e'(nt�mbgr ontreefi racy,state,Zl�e) ©t N"�"�"�.` •N7L/V - :�._„§ASSESSOR USE ONLYry ;'^ice y i y3 VUAEL E t ASSESSED VALUE ` HOMESIE$ ` -NON?RESIDENTIAL`` t G�h'€.e;+_-r .° n 'i. +` >;3 i+ t> . . .m. .�`Sr .-AT 700%OF,TIVSVALUE tr'•cu`+-t`,aVALUE .r.<.- rc� ar si>. •ty Land not exceedinge i (ima)o acre mnts.immediately (1) v"ara.e�� <. surrounding residential improvements. �,��- - � �'��' Other land (2) K^Rit e=srYV/ z Taal land(line 1 plus line 2) (3) • Dwelling (4) r^l.� r .i3.s tad 'Residential improvements or Annually s ;ra- cgi" rs;. Assessed Mobile/Manufactured Home Garage (5) kt r ...' A .>ti=sr Other improvements (6) `Y. tig Total improvements(line 4 through line 6) (7) Trial value (line 3 phis line 7) (S) I hereby certify the above is true,correct,and Signature of Assessor Date signed complete.g _ Verifying action-Signature of Auditor (}x, Date signed \ \ I 1 - Y Kr- sue: ro r : ':iTR M ._- " vt�:�%SSS'.G.>'sbei.�. ��-zy.�, ',t�rt.> =Entnsz€,+��'.m:�\�`- TANDARD;D DUCTION'ALLOWANCE_:a-Gs:.�" .... .'t -m�-r....-�x'�- '�' 20Pay 20_ ,f rkLesser of 1/2 Homestead N S i t c d. valuauon or S35.000 1 IDate s"geed --- Signature of Auditor t ig i Crl) Yp`UX I (0 (/