Mobile Home_Stocker ' 't I I- YEAR
'/"- ' CLAIM FOR HOMESTEAD PROPERTY TAX FORM
% CREDIT/STANDARD DEDUCTION HC10
' Fo
r;: State Rem 5173(R6/1-03) y Fit,Presufbed by the Department of Local Government Financeg�
INSTRUCTIONS:See rovotio efds far=instructions.
as�i''? Sffpsi-"z,,,,..1T.v.- * arvi -.:,..„ -h, ,r�„-."*S ,° TiC6 _ERTIFICATION STATEMENT ,„„. ..e' Y` -,{t.. L> ,-, D �- : }
3a yr G .idt- � I,n�.: �19. -n�`-4�=# 1+-T_
��� 1 ti 2006
I(We) certify that on the 1st day of March, 20
I(We)occupied as ur principal place of residence the following described real property for which a Homestead-Bitip�yT Credit is hereby claimed:
❑ I(We)owned 0 Are buying under contract GIBSrr�1LLLL
Have a bene dal interest in the entity that is liable for the property taxes on the property and that owns theO property or isibluylrc2Mder a contract.
tairill'Iw' 4st t:_ " ... ere ttitONTRACT.'RECORDEDT.tre ' 93 'l.a.;i§ r- F ,, >LT.-F .r-,4
If buying on contract.Fee Simple owner's name
Recorder's office where contract is re Record number Page'
s •s yr.-+ =S A '., :-e s: syTZteA'F v sssyl .-T
'.. rf<:�'t:s�y I, �1�'�'�_a�`/�!^.'Z�'. r^t� �at�-�v�.P.ROP,ERT.Y.DESCRIP,TION:'.��.n.t.�...'r......a-/.. - :u—. tr-^-`�-�.a`�' G.�a�+.4�+�..-�,. ;s
+CO3/10 - Township Taxing di rid men,to nsh,p) ‘,.._,2
Pa I ber Legal description Is the property in question: rr�� �—
- /197 / 9 X /, 7 ElL Real property 3biie Hem (/.C.6-1.1-7)
If any portion of the residential structure or the d not exceeding one(1)acre that immediately surrounds that structure is used to produce income.describe use and portion
of the property utilized to produce income.
,'- .4 abite 421021.P Z)
31/0-0052y- Ca eras— q 'O o c 4A2
- .rt- r gp.a oz.. ` ,,PROP.ERTY;OWNEDiBYCL'AIMANtiwoTHER'000NTIES+F` i -"`i`—y i
4County Township County 'Township
ieI hereby certify the above statements are true,correct and complete. S Claimant
li ^^d1dress(number and street,city,state,ZIP code)
tf • go."( S—r.)- OWe,_riijrfr rea, y'JL. '/
t
l. � EBS�Rx ESN Y ?' 1V_ALU_E_d'itgrAWAT AisgrigOTAiiii AT 100/_e OF"TfV 'HOVALUED �� 3 VALUE(N$'yam'-s' �"�a
I'zliFLRiS �F+JY� -J�F Z,iy_a.S.Srn 9Fi{Co .+�'y— _F_r 5$ n+n. rAF L'�'v ll a-�F�.Ta• /17t
1 Land not exceeding 1 (one)acre immediately ,l a " -' =4-` -r",
surrounding residential improvements. (1) Z', �-"Ttitr' '�"✓„ fd. �z.
Other land ` e::',Ans ".: i
Total land(line 1 plus line 2) (2)
(3)
I.ti
Dwelling (4 r t'' f ,^.y rc --x
r 'Residential Improvements or Annually
) } "viz -'"G '-" 3 `
Assessed Mottle/Manufactured Herne Garage �# wTS3`1= .-�s .
Other improvements (6) rb ess
Trial improvements(line 4 through line 6) (7)
9
-; Total value (line 3 plus line 7) (8)
I hereby certify the above is true,correct,and Signature of Assessor Date signed
•
complete.
Verifying action-Signature of Auditor Date signed
''1 gyp+` - �;;ss�� .:n ��,.���^^'r ,;`ufl y'"a' ex, - TANDARU!DEDU ONIALI OWANCEhrr,' "xr `' r—ZU SVS5 i
�'}"�`awi ._ t,73.... : 3` c-, .. „:„ ,..n. :,M1F =b1�,.4?rxzk``ma-. _ < ..�..
20 Pay 20 II
ry
A\ Lesser of 1/2 Homestead \ / Il�ly1D (`��
uttruaaon ce S35,000• `f�.� $ \(` 1 1 0
I
Signature of Auditor 20
signed