Mobile Home_Sturgeon ? CLAIM FOR HOMESTEAD PROPERTY TAX FORM YEAR
a CREDIT/STANDARD DEDUCTION A HCIB
State Form 5473(R614-03) / 6
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' Prescribed by the Department of Local Government Finance
INSTRUCTIONS:See reverse side for filing instructions. ,--1 n'i��
a .�Firaan""a`'r' ; 1 `ie-'kt..`�W ti d; C ATION S MENTa%e+. �?�ki g a-'<.» Y••. `' .•'"s ..'"`.
I(We) ( f Yl �`�E�j � rICtoy— cem lMat On31e2190 of March.20
I(We)occupied as our prinapal place of residence the following described I property for which a Homestead Property Tax Cr is hereby claimed:
❑ I(We)owned 0 Are buying under contract / r
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Have a beneficial interest in the entity that is liable for the property taxes on the property and that ownsitthe,pv��v hor is buying under a contract.
rWart .afte`k, s AI FTW IXEri t,X40NTRACT.RECORDED . r' 'S- `ttrici : ` i %W.-''..-.as',Kik
If buying on contract,Fee Simple owner's name
Recorder's office where contract is recorded Record number Page
' 4-f1W 1 ri:Rr 2 -w i Z. -:ti- ROP,ERTN<DESCRIPTIOteW*-4”)'`g1.rtacs2`,:r 1 p-�`5'i� n.
Court Township Testing district(city town,townshr ��
P.� be, ��yu,7y�..��/� j� L e n /� �y1 the property in question:
I)11 ,W.�/ QD 1 I/OK ' 0 Real property Mobile Home(LC.6-1.1-7)
If any portion of the residential structure or the land not ex mg one Jcre that immediatklL surrounds that structurq is prpd income.describe the use and portion
of the property utilized to produce income. ) ^ t VVVVVV /ax_ca L ' II
#,avi-�r`���a:.g.tztx?ROP.ERTY,OVIINED`BY:CL'AIMANT,IN'OTHER`COUIJTIES'- 3;,, n2a' 'j7 :��;�,rir'" ,�r`'��.y' �
County Township County Township
-
i•• re of aimant
I hereby certify the above statements are true,correct and complete. ' n
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dress(number and street,city,state,ZIP code) 1 (I (( ,r
lk
(170
r `rz� - " -`=`at Ir aTR IETAX ASSESSEDVACCIE HOMESTEAD NONteRESIDENTIAI. t 3 .
ASSESSOR S NLY' VALUE RATt100?/eOFTiV s" *FVALUE('. a j. ;'VALUE s s -a sp " €� '�> x
Land not exceeding 1 (one)acre immediately `T' , ' !C
surrounding residential improvements. (1) y,. itt .. r
Other land (2) c {,
Trial land(line 1 plus line 2) (3)
Dwelling (4) '`}& $prat
Residential Improvements or Annually ,,, , c
Assessed Mobile/Manufactured Horne _ o
Garage (6) nk '' '"'F' 3
Other improvements (6) t "Y° `
-3 . c+vbi S.
Trial improvements(line 4 through line 6) (7)
Trial value (line 3 pits line 7) (8) n
I hereby certify the above is true,correct,and Signature of ssor rA Date signed
complete.
Verifying action-Signature of Auditor Date signed
ti'�'�aylra>�.'��rrr'at,'�' •" �;"'�r''�"r,-,ST _. . Epp CTION'ALLOYiIANCE..,`��"..r�z . a�� � +'�"- �'`�r'is5�=c
20_Pay 20_ /� (�
Lesser of Homestead \�
Ok $\; J `• I I\
Val
X or 535.000 .Y`` V� l U
Sig (Auditor \ Datesigrpd / n_O,r