Mobile Home_Titzer (2)r
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',�� I ratainPM�STrAD PROPERTY TAX FORM YEAR
7 '' CREDIT/STANDARD DEDUCTIdM HC10 )} 1
V ±-j• State Form 5073(R5I 10-01)
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Prescribed by the Department
of Local Government Finance ------.) SS
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fj ,U TIONS:See reverse side for filing instructions. 17 k I
4e,A. ;»:x-"`.y„3 ': -K.. ',„: ar r'.:: %_,c4rcERT1FICATION STATEMENT,?._ .'.:' ±'1:z . a._ . s L�OZ' ,.-:...-
l(We) A certify that on the 1st day of M/arrch 20
I(We)occupied as our princi ce of residence the f owing described real property for which a Homestead Property
Credos eby.daimed:
0 I(We)owned ❑ Are buying under contract c ter,.,. Tom( r+JDITOPI
rHave a beneficial interest in the entitythat is liable for the roe taxes on the roe C^ ^property rty property rty and that owns the property or is buying under a contract.
1.
i =.-:.V g 'n i e'Karr--'i: - '+z`Oq:.-.i st sta`'`-i1> CONTRACT RECORDED -'tvs .s'Nc?r;::'V.r"r '. -.8f .. :fir''--; <-c.. .
If buying on contract.Fee Simple owners name
Recorders office where contract is recorded Record number Page
94FA�z 45,,v 1 -VM , s`Lf.'4 PIRG = #.ZIP,ROP,ERT.Y-:DESCRIRTIONFa1-`;74citS2wsi.s' .-`,:}'t 4, s:a- !-)./1' xs.:, .
County Township Tad trict town,township) M )
�CC� R,fit r�.c•l U
be I�-c 1ti 994
99 description�1 i • r Is the property in question:
•1�� ❑ Real property ❑ Mobile Homo(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 used to produce income,describe the use and portion
of the property utilized to produce income. � " �" � �t a
ll to. T
+r m,t* Ln SS±'.,,. PROPERTY.OWNEDBV CalMANTIN Toni EICCOUNTIES Qu ^.Nzist;-.]it,'`zj ta ''?`_`4-±V•s !`
County Township County Township
I hereby certify the above statements are true,correct and complete. Signature of claimant
Address(number and street,city,state,ZIP code)
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r f 11 44 "' a • ' Y ei 'Rr - 4'TRUE TAXr SESSED VALUE lyHOMESTEAD v-W-1-i�NON-RESIDENTIAL'f5 --
. �3' ASSESSOR US�Ec,ONLY{ y�;.:44 .G VALUE lyre ;AT 1O OFFTTVa k4VALUE 4.SaAlit:5..3 VALUEu' ,..., 7)r_ 3.
Land not exceeding 1 (one)acre immediately 'J 11 ' F 1ts_ cc. 3
surrounding residential improvements. (1) „{ipfk3.�' £, +'~ri.;';T i -
itztag.zio
Other land (2) , -z'E
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Trial land(line 1 plus line 2) (3)
Dwelling (4) ._W r °-,..:tde df !'t.
Residential improvements
(IlL -7=Y s ta.
Garage (6) ft 4>r:�V::v�,,ae,'+N_n.,l.--.-..$.
Other improvements (6) xF r5, 'y€Ttat-
Taal improvements(line 4 through line 6) (7)
Tctal value (line 3 plus linen (6) --� 7 N Tr '.\
j"1 11
I hereby certify the above is true,correct,and Signature of Assessor ' i I{�] , Dt11 s% j eAI )/
complete. 1 � �
Verifying action-Signature of Auditor Data si
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i' ,;t -' .,<intr; A,v s wYt 1-4; c.STAND ARD.DEDUCTIONIALLOWANCEat'J*>' 4, ''--�n'�iJc't rF' k1t-t.J4�..+::
+} 20 Pa 20 f 7.--7, ' f AUCITCR I
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�OV Lesser of 1/2 Homesteaq `1-�/ \ ^ ((��
Valuation or$6,000 \ \d' , $ ' (\\ \/I `y
Sin ure of Audit \ , ' n ,�,y` `s^, 1�o Date signed