Mobile Home_Merrill ;�ri ` CLAIM FOR HOMESTEAD PROPERTY TAX /� FORM YEAR
' �+_ CREDIT/STANDARD DEDUCTION ^ A HC10
1,y Sera Fan 5479(R7 r see) A V
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INSTRUCTIONS:See reverse side Iry fling instructions.
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I(We) • �' I- • is• • alb _ a.. certify tht) l i till)13t daoyyol Mardi.20_
I(We)ooapied as ow prtndpai place of Odence the foaowirg described real property to which a Homestead Property Tax Credit is hereby chimed:
®rl I(We)owned 0 Pee buying wrier contract 7z'#J � '
Have a beneficial interest M the entity that is liable tar the property taxes an the property and that cams the ,„� a er a
Gleat-i property«�? g a contract
ta" rgn"reAt a i rA?sNeoNST: EORDEDaii kaa*#M3-astlF rti a ;s?, lg i i
d bag an wntrat Fee Stage cre eh rapes
Ramdat coca r mrdsd Is receded �/ Rend number Pape
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—i n(1• , q?Si Ei '?FROPERViDESCIUR.TIO)! :,, , f MSIVe r ;niggjgatWia
Canty Tamale Taxing district(ay,tam,tt n# )
dal-til�t l� Lepet desa p m e, pe
ilia Ns property b question:
L/1{ ,�+3'� l ` � ❑Real pidny ❑ Moh Home
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6any paten al the S atrumra a the lied notesceedirep one(I)ace dial in surrounds thud mumrs Is used to Income describe the use end patios
dew prxerty v�'eAae borne. v l (//J_G /JC //
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id— it 9 a‘g(fa 4 L33 3/s--/G
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" % :.1:3.t3M ;40iioPQir,Y.ovix®iBY CL J)dniNT')ii:oriiER:courriieSYYS+ t ? e`M' MMit + I
Caanty Township County Township
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ere true,caredcomplete. j52e7i
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'AS' ESSOR USE-74181 SV :ill '7RUErTearA lASSESSm;VALUE:Urtai E3TEADt. _ 'h O14:itE51DEN71Al =b
R7S°tLR% li7'^.S�S'F.!?dtt:";' ki y>±ri :c:.anYAL.E a.. ILAT�10 Scif W.41-Fa' 1YAL'UcC h g�!': VAWA i
exoeed,g ( ) atety Y•'''t 'kf t' )'�74.T 705:�,�;:,Land not tone aae'dmedi glgCw
surrounding residen5al b.yausttmnts. (t) iA C t` ��+.i'
rein n
Other lend (2) ? e �
Teal land(rne t pan&re 2) (3)
Residental improvements a Anmralfy DvreDrp (<) e-: ail �
Assessed Mobile I Masrta urad Hane
Garage (6) Q? -�'., ' ' �... , Ai'i
'I S lK{ ><'>'
Other improvements 1 (6) _.� .
Trial unproversnb(Ere 4 through 9ne 6) \\\ (7)
j"+value (rne3 plus 6ne7) 1\ (8)
If1$reby certi fy the above is true.cafe*.and Sipmere o Maas Date signed
Vaitybq eaten-Sc,tze ofAuttr Oats signed
mo} tWalI reran ".. ✓« 3tivsrewDARn:)imuenoxtn)'LowAHCEfk#'.at,9r'd AlKnk R&di f_ :1